Hirn M, Niinikoski J
Department of Surgery, University of Turku, Finland.
Ann Chir Gynaecol. 1989;78(4):277-81.
Eleven cases of perineal necrotizing fasciitis were treated in the Department of Surgery, University of Turku, Finland. In 10 cases the diagnosis was made on the basis of the fulminating progression of the infection to scrotal gangrene, identification of multiple underlying pathogenic organisms and toxaemia. In one female patient a corresponding infection developed in the labia majora. Each patient suffered nonspecific symptoms before the gangrene became evident. The management included surgical debridement of the necrotic tissue with incisions and drainage of the involved areas, antibiotic therapy and hyperbaric oxygen (HBO) treatment. The infection originated from the anorectal area in 5 patients, 1 patient had sustained scrotal trauma and in 5 cases the underlying condition was unknown. Colostomy was performed in 6 patients. One patient died 2 days after the admission. All the infections proved to be multimicrobial. Hyperbaric oxygenation was employed as a therapeutic adjunct in the present series, but it should neither replace nor delay surgical intervention. The key points in the management include early diagnosis with prompt surgical debridement and antibiotic therapy. After healthy granulation has appeared, the healing time can be shortened with reconstructive surgical procedures.
芬兰图尔库大学外科治疗了11例会阴坏死性筋膜炎患者。10例患者的诊断基于感染迅速发展为阴囊坏疽、多种潜在致病微生物的鉴定以及毒血症。1例女性患者在大阴唇出现了相应感染。每位患者在坏疽明显之前都有非特异性症状。治疗措施包括对坏死组织进行手术清创，对受累区域进行切开引流、抗生素治疗和高压氧（HBO）治疗。5例患者感染起源于肛门直肠区域，1例患者阴囊受过伤，5例患者的潜在病因不明。6例患者进行了结肠造口术。1例患者入院2天后死亡。所有感染均为多种微生物感染。本系列采用高压氧作为治疗辅助手段，但它既不能替代手术干预，也不应延迟手术干预。治疗的关键要点包括早期诊断并迅速进行手术清创和抗生素治疗。出现健康肉芽后，可通过重建性外科手术缩短愈合时间。
