Moorthy K, Rao P P, Supe A N
Department of Surgery, Seth G.S. Medical College, Parel, Mumbai, India.
J R Coll Surg Edinb. 2000 Oct;45(5):281-4.
Necrotizing perineal infection or Fournier's gangrene is an uncommon but lethal complication of ischiorectal fossa abscesses. It is associated with a high mortality, especially in diabetics and immunocompromised individuals. Attempts have been made to study factors which could serve as prognostic indicators. The role of faecal diversion has not been clearly determined.
The medical records of 8 patients who presented with necrotizing perineal infection as a complication of ischiorectal fossa abscesses were reviewed. Various parameters were studied to see if any of them could serve as predictors of outcome. Mean surface area of involvement was calculated using modified burns assessment criteria. To study the effect of colostomy on the general condition of the patient the physiological and biochemical parameters before and after the procedure were compared. Statistical analysis was done using the unpaired and paired 't' tests.
The mean age of the patients was 50.6 +/- 10.3 years. Five patients were diabetic, of whom four died; all the non-diabetics survived. The mean surface area of involvement was 5.1 +/- 0.75%, among the survivors, and 9.6 +/- 3.4% among the non-survivors. Colostomy was performed in four patients one of whom died. While in one patient the colostomy was created along with the initial radical debridement, in three other patients it was formed on days three, five and five, respectively. There was a significant improvement in their general status and biological parameters. All patients with testicular involvement died.
Evidence of systemic sepsis at presentation, extent of tissue and testicular involvement, a low haematocrit, a high blood urea and creatinine and a low serum albumin, were associated with a higher mortality. Prompt recognition of the condition, urgent radical surgical debridement and the use of appropriate antibiotics are the mainstays of management. Formation of a diverting colostomy appears to favour survival.
坏死性会阴部感染或福尼尔坏疽是坐骨直肠窝脓肿一种罕见但致命的并发症。它与高死亡率相关，尤其是在糖尿病患者和免疫功能低下者中。人们已尝试研究可作为预后指标的因素。粪便转流的作用尚未明确确定。
回顾了8例因坐骨直肠窝脓肿并发症而出现坏死性会阴部感染患者的病历。研究了各种参数，以查看其中是否有任何参数可作为预后的预测指标。使用改良的烧伤评估标准计算平均受累表面积。为研究结肠造口术对患者一般状况的影响，比较了手术前后的生理和生化参数。采用非配对和配对t检验进行统计分析。
患者的平均年龄为50.6±10.3岁。5例患者患有糖尿病，其中4例死亡；所有非糖尿病患者均存活。幸存者的平均受累表面积为5.1±0.75%，非幸存者为9.6±3.4%。4例患者接受了结肠造口术，其中1例死亡。1例患者在初次根治性清创时同时进行了结肠造口术，另外3例患者分别在第3天、第5天和第5天进行了结肠造口术。他们的一般状况和生物学参数有显著改善。所有睾丸受累的患者均死亡。
就诊时存在全身脓毒症的证据、组织和睾丸受累程度、低血细胞比容、高血尿素和肌酐以及低血清白蛋白与较高的死亡率相关。及时识别病情、紧急进行根治性手术清创和使用适当的抗生素是治疗的主要方法。形成转流性结肠造口术似乎有利于生存。
