Paty R, Smith A D
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York.
Urol Clin North Am. 1992 Feb;19(1):149-62.
Fournier's gangrene is an aggressive disease affecting the perineum. Clearly, it can no longer by considered idiopathic in its origin, as most infection can be localized to a cutaneous, urethral, or rectal source. It presents in a broad age range and can have an indolent onset, thus requiring a high index of suspicion. It may be fulminant and progressive in the case of immunocompromise and underlying debilitating illnesses. Despite aggressive antibiotic therapy and debridement, it is associated with a high mortality rate. This rate has been higher in older patients, those with a rectal focus, and diabetics. Hyperbaric oxygen therapy has shown some promise in shortening hospital stays, increasing wound healing, and decreasing the gangrenous spread when used in conjunction with surgical debridement and antibiotics. New reconstructive efforts, such as medial thigh myocutaneous flaps, have improved the cosmetic aftermath of the extensive debridement. Fournier's gangrene remains a true urologic emergency, which mandates aggressive initial care by means of early recognition, early hemodynamic stabilization, and the institution of parenteral broad-spectrum antibiotics. This is followed by multiple debridements and in some cases urinary or rectal diversion. The concomitant use of hyperbaric oxygen therapy in selected cases followed by meticulous reconstructive surgery and salvage has further reduced the mortality rate and improved the cosmetic outcome.
福尼尔坏疽是一种侵袭会阴部的疾病。显然，其病因不能再被认为是特发性的，因为大多数感染可定位到皮肤、尿道或直肠来源。它在广泛的年龄范围内发病，起病可能隐匿，因此需要高度怀疑。在免疫功能低下和存在基础衰弱性疾病的情况下，它可能呈暴发性且进行性发展。尽管采用了积极的抗生素治疗和清创术，但它的死亡率仍很高。在老年患者、直肠感染源患者和糖尿病患者中，死亡率更高。高压氧治疗在与手术清创术和抗生素联合使用时，已显示出在缩短住院时间、促进伤口愈合以及减少坏疽扩散方面有一定前景。新的重建方法，如大腿内侧肌皮瓣，改善了广泛清创术后的外观效果。福尼尔坏疽仍然是真正的泌尿外科急症，需要通过早期识别、早期血流动力学稳定以及使用肠外广谱抗生素进行积极的初始治疗。随后进行多次清创，在某些情况下进行尿路或直肠改道。在选定病例中联合使用高压氧治疗，随后进行细致的重建手术和挽救措施，进一步降低了死亡率并改善了外观效果。
