坏死性筋膜炎：56例病例的对比分析
Necrotizing fasciitis: a comparative analysis of 56 cases.
作者信息
Legbo Jacob Ndas, Shehu Bello Bala
机构信息
Plastic & Reconstructive Surgery Unit, Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
出版信息
J Natl Med Assoc. 2005 Dec;97(12):1692-7.
BACKGROUND
The term necrotizing fasciitis (NF) is now used in a generic sense to include all diffuse necrotizing soft-tissue infections except gas gangrene. It is a synergistic, polymicrobial soft-tissue infection associated with rapid progression, extensive necrosis, profound systemic toxemia, considerable morbidity and a high mortality rate. Although the disease is no respecter of age and affects a wide age group, adults are known to be more commonly affected than children.
AIMS
To highlight the differences and similarities in the modes of presentation and results of intervention of NF in children and adults.
PATIENTS AND METHODS
A four-year prospective descriptive analysis of all consecutive patients with NF (excluding cancrum oris and Fournier's gangrene) treated at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, from January 2001 to December 2004.
RESULTS
A total of 56 patients were treated of which 32 (57.1%) were children < or = 15 years, while the remaining 24 (42.9%) were adults aged >15 years. There were 31 males and 25 females, giving the male-to-female ratio of 1.2:1; the corresponding ratios for children and adults were 1.7:1 and 1.1:2, respectively. The age ranged from six days to 70 years (mean 19.9 years). Trauma and minor skin infections were the main precipitating factors. The total body surface area (BSA) involved ranged from 1-16% (children 2-16%, adults 1-7%) with a mean of 4.3% (children 5.9%, adults 2.7%). The trunk was the most commonly involved anatomical region of the body (50.0%) in children, while in adults it was the lower limb (54.2%). In both children and adults, infection was mainly polymicrobial. The most common mode of wound resurfacing was by second intention in children (46.9%) and split-thickness skin grafting (STSG) in adults (37.5%). Septicemia was a common complication in both age groups. Mortality was 9.4% and 16.7% among children and adults, respectively.
CONCLUSION
NF is more common in children than adults in northwestern Nigeria. Early recognition, aggressive surgical treatment and supportive therapy remain the essential keys to success.
背景
坏死性筋膜炎（NF）一词现被广泛用于指代除气性坏疽之外的所有弥漫性坏死性软组织感染。它是一种协同性、多微生物引起的软组织感染，具有进展迅速、广泛坏死、严重全身毒血症、高发病率和高死亡率的特点。尽管该疾病并不受年龄限制，可影响各个年龄段人群，但已知成人比儿童更易感染。
目的
强调儿童和成人坏死性筋膜炎在临床表现方式及干预结果上的异同。
患者与方法
对2001年1月至2004年12月在尼日利亚索科托的乌斯曼努·丹福迪奥大学教学医院接受治疗的所有连续性坏死性筋膜炎患者（不包括坏疽性口炎和福尼尔坏疽）进行为期四年的前瞻性描述性分析。
结果
共治疗56例患者，其中32例（57.1%）为15岁及以下儿童，其余24例（42.9%）为15岁以上成人。男性31例，女性25例，男女比例为1.2:1；儿童和成人的相应比例分别为1.7:1和1.1:2。年龄范围为6天至70岁（平均19.9岁）。创伤和轻微皮肤感染是主要诱发因素。累及的全身表面积（BSA）范围为1%至16%（儿童为2%至16%，成人为1%至7%），平均为4.3%（儿童为5.9%，成人为2.7%）。儿童中最常累及的身体解剖区域是躯干（50.0%），而成人中是下肢（54.2%）。儿童和成人的感染主要都是多微生物感染。儿童伤口愈合的最常见方式是二期愈合（46.9%），成人是中厚皮片移植（STSG）（37.5%）。败血症在两个年龄组中都是常见并发症。儿童和成人的死亡率分别为9.4%和16.7%。
结论
在尼日利亚西北部，坏死性筋膜炎在儿童中比在成人中更常见。早期识别、积极的手术治疗和支持性治疗仍然是成功的关键。
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