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中華民國泌尿科醫學會雜誌

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篇名 Management of Fournier's Gangrene - Experience with 57 Patients
卷期 9:3
並列篇名 福耳尼埃氏壞疽-57位病人的治療經驗
作者 劉冠麟陳志碩馮思中朱聖賢
頁次 121-125
關鍵字 福耳尼埃氏壞疽壞死性筋膜炎會陰感染Fournier's gangrenenecrotizing faciitisperineal infectionTSCI
出刊日期 199806

中文摘要

福耳尼埃氏壞疽是會陰及生殖部位筋膜快速進行的壞死性感染(壞死性筋膜炎),並且常合併覆蓋其上皮膚的壞疽。自民國74年1月至民國86年8月,共有57位福耳尼埃氏壞疽病患於林口長庚醫院接受治療。這些病患的年齡由28歲至82歲(平均55歲)。其中28位病患有糖尿病;10位病患有肝硬化。57位病患中,25位感染部位侷限在會陰、陰囊、陰莖和睪丸;另外32位病患則蔓延至腹股溝、腹部、腰部或大腿。進行細菌培養的38位病患中,有36位培養出多種菌種,只有2位是單一菌種。33位病患源自肛門直腸的感染,5位病患源自泌尿生殖道的感染。病患均接受廣泛性的清創手術,黃效性的抗生素治療,及經常的傷口換藥處理。23位病患接受結腸造口手術,6位病患接受恥骨上膀胱造廔手術。有12位病患須進行重建手術。共有26位病患發生敗血性休克,並造成14位病患死亡。經研究結果發現:蔓延的福耳尼埃氏壞疽比侷限性的福萃尼埃氏壞疽有較高的死亡率,敗血症是造成病患死亡最重要的咰素,因此我們的治療策略便是在防止福耳尼埃氏壞疽的蔓延,以及控制敗血症的進展;而源自肛門直腸感染之福耳尼埃氏壞疽有較高的死亡率,對於源自肛門直腸感染之福耳尼埃氏壞疽,早期的結腸造口手術可能降低其死亡率。

英文摘要

Fournier’s gangrene is a rapidly progressive necrotizing infection of the perineal and genital fascia (necrotizing fasciitis). This paper analyzes the factors related to the mortality of patients with Fournier’s gangrene and clarifies the treatment strategy of Fournier’s gangrene with different origins. From Jan. 1985 to Aug. 1997 , 57 patients with Fournier’s gangrene were treated at the Chang Gung Memorial Hospital in Taoyuan. Their medical records were reviewed and analyzed. The patients’ ages ranged from 28 to 82 yr (mean 55). Twenty-eight patients had diabetes mellitus and 10 had liver cirrhosis; 25 patients had lesions limited to the perineum and scrotum; however, 32 patients had lesions which had spread to the inguinal area, abdomen, or thigh. Fournier’s gangrene of anorectal origin was observed in 33 patients and of urogenital origin in 5 patients. An average of 2.47 debridements per patient were performed. Colostomy was performed in 23 patients and suprapubic cystostomy in 6 patients. Septic shock was ob-served in 26 patients and all of the 14 expired patients died of sepsis. In conclusion, the mortality rate of Fournier’s gangrene with extensive lesions might be higher than that with localized le-sions. Bactermia and sepsis are the major indicators of morality rate for Fournier’s gangrene. Fournier’s gangrene of anorectal origin might have a higher mortality rate than that of uro-genital origin. Diverting colostomy performed at the onset might be beneficial in cases of infec-tion arising from anorectal origin. (J Urol R.O.C., 9:121-125,1998)

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