Eke N
Urology Unit, Department of Surgery, University of Port Harcourt, Port Harcourt, Nigeria.
Br J Surg. 2000 Jun;87(6):718-28. doi: 10.1046/j.1365-2168.2000.01497.x.
Although there is much consensus, certain controversies exist regarding the management of Fournier's gangrene.
Publications in English on Fournier's gangrene from January 1950 to September 1999 were obtained through the Medline database and relevant reference lists in publications. It was possible to identify 1726 cases for study. Data extracted for review included country of reported cases, number of patients in each report and relevant clinical features.
Fournier's gangrene occurs worldwide. However, its definition has generated considerable controversy as efforts are made to refine the original description in the light of increasingly understood aetiological factors. Attempts to classify the disease into primary and secondary forms have not been successful. The basic pathological process, necrotizing fasciitis, has been identified in the perineum of women and children, although the disease afflicts the male more often than the female. Most reported cases have occurred in the USA and Canada. The major sources of sepsis are the local skin, colon, anus and rectum, and the lower urinary tract. Colonic, anal and rectal sources carry the worst prognosis. Diabetes mellitus is important in aetiological terms. Rare causes include vasectomy and circumcision. Investigations are essential to define the cause of an episode but not for the diagnosis of the disease. Early aggressive treatment of Fournier's gangrene and underlying conditions is essential. Hyperbaric oxygen and honey are treatment modalities yet to be universally adopted. Risk of death, 16 per cent overall in this series, is related to the patient's condition at presentation.
Controversies over the definition of Fournier's gangrene persist but these do not affect the treatment options. The diagnosis is made on clinical grounds. The occurrence of the disease in women is under-reported and may go unrecognized by some clinicians. Some treatment options, such as hyperbaric oxygenation and radical excision, remain controversial.
尽管存在诸多共识，但在福尼尔坏疽的治疗方面仍存在一些争议。
通过Medline数据库以及出版物中的相关参考文献列表，获取了1950年1月至1999年9月期间关于福尼尔坏疽的英文出版物。共识别出1726例可供研究的病例。提取用于综述的数据包括报告病例的国家、每份报告中的患者数量以及相关临床特征。
福尼尔坏疽在全球范围内均有发生。然而，随着人们对病因因素的认识不断深入，对其定义的细化引发了相当大的争议。将该疾病分为原发性和继发性形式的尝试并未成功。尽管该疾病在男性中的发病率高于女性，但在女性和儿童的会阴部位也已发现了基本的病理过程——坏死性筋膜炎。大多数报告的病例发生在美国和加拿大。败血症的主要来源是局部皮肤、结肠、肛门和直肠以及下尿路。结肠、肛门和直肠来源的预后最差。从病因学角度来看，糖尿病很重要。罕见病因包括输精管切除术和包皮环切术。进行检查对于明确发病原因至关重要，但对于疾病的诊断并非必需。早期积极治疗福尼尔坏疽及其潜在疾病至关重要。高压氧和蜂蜜作为治疗方式尚未被普遍采用。在本系列中，总体死亡率为16%，这与患者就诊时的病情有关。
关于福尼尔坏疽定义的争议仍然存在，但这些并不影响治疗选择。诊断基于临床依据。该疾病在女性中的发生率报告不足，可能未被一些临床医生所认识。一些治疗选择，如高压氧疗和根治性切除，仍存在争议。
