Clayton M D, Fowler J E, Sharifi R, Pearl R K
Division of Urology, University of Illinois College of Medicine, Chicago 60680.
Surg Gynecol Obstet. 1990 Jan;170(1):49-55.
This analysis of our experience with 57 men with necrotizing fasciitis of the genitalia was done to identify prognostic variables and to assess the results of a treatment policy of immediate and, if required, repetitive surgical debridements. The mean age of the patients was 55 years. Thirty-eight patients were alcoholics or diabetics, or both. All of the infections were of a genitourinary, anorectal or cutaneous source. Thirty-five per cent of the infections were confined to the genitalia and 65 per cent extended to the abdominal wall or thigh, or both. Forty-seven patients survived. Survival was associated significantly with a younger age, a serum blood urea nitrogen (BUN) level of less than 50 milligrams per deciliter at presentation, the absence of a constellation of abnormalities at presentation consistent with sepsis and a decreased incidence of major complications after initial débridement (p less than 0.05 to 0.01). Survival was not associated with the extent of infection, the duration of symptoms before hospitalization, systemic risk factors, the source of infection, abnormal findings at presentation (excluding a BUN of greater than 50 milligrams per deciliter) and the bacteriologic factors of the infection. Both localized and extensive necrotizing fasciitis of the male genitalia are potentially lethal disorders that require prompt treatment.
对57例患有生殖器坏死性筋膜炎的男性患者的经验进行了此项分析，以确定预后变量，并评估立即进行以及必要时重复进行外科清创的治疗策略的效果。患者的平均年龄为55岁。38例患者为酗酒者或糖尿病患者，或二者兼具。所有感染均源于泌尿生殖系统、肛门直肠或皮肤。35%的感染局限于生殖器，65%的感染扩展至腹壁或大腿，或二者皆有。47例患者存活。存活与以下因素显著相关：年龄较轻、就诊时血清血尿素氮（BUN）水平低于50毫克/分升、就诊时不存在与脓毒症相符的一系列异常情况以及初次清创后主要并发症的发生率降低（p值小于0.05至0.01）。存活与感染范围、住院前症状持续时间、全身危险因素、感染源、就诊时的异常发现（不包括BUN大于50毫克/分升）以及感染的细菌学因素无关。男性生殖器局部和广泛的坏死性筋膜炎均为潜在致命性疾病，需要及时治疗。
