Brunet C, Consentino B, Barthelemy A, Huart L, Pirro N, Cesari B, Sielezneff Y, Sastre B, Farisse J
Services de chirurgie générale et urgences, département informations médicales, hôpital Sainte-Marguerite, Marseille, France.
Ann Chir. 2000 Jun;125(5):420-7. doi: 10.1016/s0003-3944(00)00215-7.
The objective of this retrospective study was to report the results of a series of 81 cases of perineal gangrene treated in the same center.
From 1988 to 1998, 81 patients (64 males, 17 females, mean age: 58 years) with perineal gangrene were treated by a medico-surgical team, by means of a protocol combining appropriate intensive care measures based on a new bacteriologic concept of infectious agents, extensive excisions and drainage of the infraperitoneal region and hyperbaric oxygen therapy.
The mortality rate was 24.7%. Mean duration of intensive care stay was 19 days, mean duration of hospital stay was 31 +/- 4 days (range: 6 to 60 days). Risk factors were: age > 68 years (p = 0.001), shock (p = 0.83), subcutaneous crepitation (p = 0.25) and severity index > 10 (p = 0.003). Sequelae were anal incontinence (n = 3) and permanent colostomy (n = 5). Secondary plastic reconstruction was necessary in four patients. There were no urologic or genital sequelae.
Perineal gangrene is still a very serious disease. The time to treatment, the simplified severity index and consideration of bacteriologic combinations are the main prognostic factors.
本回顾性研究的目的是报告在同一中心治疗的81例会阴坏疽病例的结果。
1988年至1998年，一个内科-外科团队采用一种方案治疗了81例会阴坏疽患者（64例男性，17例女性，平均年龄：58岁），该方案结合了基于感染病原体新细菌学概念的适当重症监护措施、广泛的腹膜下区域切除和引流以及高压氧治疗。
死亡率为24.7%。重症监护平均住院时间为19天，平均住院时间为31±4天（范围：6至60天）。危险因素为：年龄>68岁（p = 0.001）、休克（p = 0.83）、皮下捻发音（p = 0.25）和严重程度指数>10（p = 0.003）。后遗症为肛门失禁（n = 3）和永久性结肠造口术（n = 5）。4例患者需要进行二期整形重建。无泌尿系统或生殖系统后遗症。
会阴坏疽仍然是一种非常严重的疾病。治疗时间、简化的严重程度指数以及对细菌组合的考虑是主要的预后因素。
