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題名 | 福耳尼埃氏壞疽--會陰生殖器的壞死性筋膜炎=Fournier's Gangrene-Necrotizing Fasciitis of the Perineum and Genitalia |
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作者 | 李俊達; 簡守信; | 書刊名 | 慈濟醫學 |
卷期 | 9:2 1997.06[民86.06] |
頁次 | 頁115-122 |
分類號 | 415.85 |
關鍵詞 | 福耳尼埃氏壞疽; 壞死性筋膜炎; Fournier's gangrene; Necrotizing fasciitis; |
語文 | 中文(Chinese) |
中文摘要 | 神耳尼埃氏壞疽 (Fournier's gangrene) 是發生於會陰及生殖器的壞死性筋膜炎 ,可見於男性或女性。它的特徵是由嗜氧菌和厭氧菌的協同性感染造成皮下血管栓塞,而引 起筋膜和皮下組織壞死。雖然目前有抗生素的使用及外科技術的進步,它仍有很高的死亡率 。 本文描述佛教慈濟醫院從民國 77 年 10 月到 85 年 9 月,8 年間 14 例福耳尼埃氏壞 疽的治療經驗。男性有 10 例。 女性 4 例。年齡從 30 歲到 71 歲,平均 52.3 歲。關於 致病因,9 例 (64%) 病人原因不明。共 11 例 (79%) 病人合併其他全身性疾病,例如糖尿 病,肝硬化、心臟病、惡性腫瘤等。 12 例病人做病灶細菌培養,結果以大腸桿菌最常見, 共 8 例 (67%),其次為克萊勃士桿菌,變形桿菌。總計 11 例 (92%) 病人培養出革蘭氏陰 性桿菌,3 例 (25%) 培養出革蘭氏陽性球菌,2 例培養出厭氧菌。共有 4 例病人死亡,死 亡率為 28%。 其中 3 例死於敗血症,1 例死於合併的心臟病。存活的 10 例病人,傷口處 理的方法如下:1 例靠二度癒合,2 例直接縫合,3 例植皮, 2 例利用大腿皮瓣,另 2 例 利用股薄肌肌皮瓣來重建傷口。 |
英文摘要 | Fournier's gangrene is a necrotizing fasciitis involving the perineum and genitalia. It can occur in either sex. The disease usually is caused by the synergistic effects of infection by aerobic and anaerobic organisms, which results in thrombosis of subcutaneous vessels and eventual necrosis of the fascia and subcutaneous tissue. Despite the use of modern antibiotic therapy and surgical techniques, it still carries a high mortality rate. Fourteen patients (mean age 52.3 years) with Fournier's gangrene were treated at the Buddhist Tzu Chi General Hospital from October 1988 to September 1996. There was an absence of discernible cause in 9 patients (64%). Eleven patients (79%) had other associated systemic diseases such as diabetes mellitus, liver cirrhosis, heart disease, and malignancy. Cultures of infected tissue were done in 12 patients. E. coli (8 patients, 67%) was the mostfrequently isolated organism, followed by Klebsiella (33%) and Proteus (25%). Aerobic Gram-negative rods were isolated from 11 patients (92%) and aerobic Gram-possitive cocci from 3 patients (25%). Only 2 anaerobic cultures had positive results. Four (28%) of 14 patients died. Three died of sepsis and the other died of associated heart disease. Wound management of the 10 survivors consisted of secondary healing (1 patient), direct repair (2 patients), skin graft (3 patients), thigh flap (2 patients) and gracilis myocutaneous flap (2 patients). |
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