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- Prognostic Factors and Strategy of Treatment in Fournier's Gangrene: A 12-Year Retrospective Study
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- Hyperbaric Oxygen Therapy in Extensive Fournier's Gangrene--Our Experience of Treatment
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題名 | Prognostic Factors and Strategy of Treatment in Fournier's Gangrene: A 12-Year Retrospective Study=福耳尼埃氏壞疽的預後因子與治療策略:12年的臨床經驗 |
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作 者 | 陳志碩; 劉冠麟; 陳孝文; 周建中; 莊正鏗; 朱聖賢; | 書刊名 | 長庚醫學 |
卷期 | 22:1 1999.03[民88.03] |
頁次 | 頁31-36 |
分類號 | 415.85 |
關鍵詞 | 福耳尼埃氏壞疽; 壞死性筋膜炎; 結腸造口; Fournier's gangrene; Necrotizing fasciitis; Diverting colostomy; |
語文 | 英文(English) |
中文摘要 | 背景:福耳尼埃氏壞疽是發生在生殖器附近一種既猛爆且致命的感染症,雖然如 此,其臨床表現卻難以預測,這項回溯性的研究是分析此壞疽其可能的預後因子。 方法:此項研究共收集長庚醫院自1985年1月到1996年12月間,57位病患的資料,我們藉此 回溯性研究,分析各種福耳尼埃氏壞疽可能的預後因子,其中包括年齡,延遲診斷,住院日 ,潛在性疾病,臨床表徵,壞疽來源,壞疽範圍,細菌感染,暫時性腸造口與死亡率等等。 結果:擴散性福耳尼埃氏壞疽病人與局限性病灶患者其死亡率分別為31.3%與16% ( p = 0.227 ),直腸肛門病灶與泌尿道或其他非特異性病源其死亡率分別為 30.3 %, 0 %與 40.0 %( p = 0.712 ),此外在直腸肛門病源患者中,接受原發性或續發性暫時 性結腸造口的死亡率分別為 16.7 %與 40.0 %,然而在直腸肛門病源患者,若未接受結腸 造口的死亡率卻為 29.4 %,福耳尼埃氏壞疽病人在急診若曾發生敗血性休克,其死亡率更 可高達 53.8 %,這數字遠高於未曾發生敗血休克之患者( 0 %), 且有統計學上之意義 ( p < 0.001 )。 結論:福耳尼埃氏壞疽是一種進展快速且威脅性命的生殖器感染症,雖然年齡,病患之潛在 性疾病,壞疽來源,壞疽範圍與做不做暫時性結腸造口,並無法視為預後因子,對直腸肛門 病源患者,若有被嚴重感染的機會與顧慮,及早做暫時性結腸造口似乎會有較低的死亡率, 在此回溯性研究,敗血性休克是福耳尼埃氏壞疽患者在急診室最重要且唯一有意義的預後因 子。 |
英文摘要 | Background: Fournier's gangrene (FG) is a fulminant and fatal infection of the genitalia. However, the clinical course is unpredictable. This study retrospectively analyzed the possible prognostic factors of FG. Methods: Data obtained from 57 patients treated for FG from January 1985 through December 1996 were retrospectively analyzed. Possible prognostic factors including age, diagnostic delay, hospital stay, underlying diseases, clinical symptoms, origins, extents, bacteriologic findings, diverting colostomy and mortality rate were all considered in the analysis. Results: Patients with extensive or localized FG had mortality rates of 31.3% and 16.0%, respectively (p=0.227). The mortality rates of patients with FG of anorectal, urogenital and non-specific origin were 30.3%, 0% and 40.0%, respectively (p=0.712). The mortality rates of patients with FG of anorectal origin who received primary or secondary diverting colostomy were 16.7% and 40.0%, respectively. However, the mortality rate of patients with FG of anorectal origin who did not undergo diversion was 29.4%. The mortality rate of patients with FG presenting with septic shock at emergency was 53.8% as compared with 0% in those without septic shock (p<0.001). Conclusion: Fournier's gangrene is a rapidly progressive and life threatening infection of the genitalia. Age, underlying diseases, origin, extent and fecal diversion can not be regarded as prognostic factors of FG. Early primary diverting colostomy may reduce the mortality rate in those with severe infection of anorectal origin. Presence of septic shock in those with FG is the most important and the only factor related to death. |
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