Department of Dermatology, Mayo Clinic, Rochester, MN.
Department of Surgery, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2016 Sep;91(9):1267-79. doi: 10.1016/j.mayocp.2016.05.001. Epub 2016 Jul 31.
Postoperative pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by PG at surgical incisions. It is often misdiagnosed as wound infection, and pathergy may complicate wound debridement. From September 1, 2013, through November 30, 2013, a literature search was conducted of articles published from January 1, 1978, through December 31, 2012. We referenced PubMed, MEDLINE, and Mayo Clinic Libraries using the keywords pyoderma gangrenosum, postoperative pyoderma gangrenosum, postsurgical pyoderma gangrenosum, superficial granulomatous pyoderma, pathergic pyoderma, and pyoderma gangrenosum associated with surgery, incision, breast, and wound dehiscence. In addition, all titles from PubMed with the words pyoderma gangrenosum were reviewed manually for postoperative cases. Of 136 patients, 90 (66%) did not have associated systemic diseases. If a comorbidity was present, hematologic disorders were most common. In addition, 29% (28) of women had predisposing disease vs 53% (19) of men. Women had more frequent breast involvement (P<.001); chest involvement was more common in men (P=.005). Girls and women aged 13 to 64 years had more frequent breast involvement (P=.01). Sites were distributed equally for men regardless of age (P=.40). Antibiotic drug therapy was begun and debridement occurred in 90% (110 of 122 treated patients) and 73% (90 of 123 available patients), respectively. Postoperative PG has less association with systemic disease than its nonpostoperative counterpart. Antibiotic drug therapy is routinely initiated. Affected sites are often debrided, causing additional wound breakdown. Early diagnosis may prevent complications.
术后坏疽性脓皮病（PG）是一种以 PG 为特征的中性粒细胞皮肤病，发生于手术切口。它常被误诊为伤口感染，而且同形反应可能使伤口清创复杂化。从 2013 年 9 月 1 日至 2013 年 11 月 30 日，我们对 1978 年 1 月 1 日至 2012 年 12 月 31 日期间发表的文章进行了文献检索。我们使用了 pyoderma gangrenosum、postoperative pyoderma gangrenosum、postsurgical pyoderma gangrenosum、superficial granulomatous pyoderma、pathergic pyoderma 和 pyoderma gangrenosum associated with surgery, incision, breast, and wound dehiscence 等关键词在 PubMed、MEDLINE 和 Mayo Clinic Libraries 中进行了检索。此外，我们还对 PubMed 中所有带有“pyoderma gangrenosum”字样的标题进行了手动审查，以寻找术后病例。在 136 例患者中，90 例（66%）无相关系统性疾病。如果存在合并症，则最常见的是血液系统疾病。此外，29%（28 例）的女性有易患疾病，而 53%（19 例）的男性有易患疾病。女性更易发生乳房受累（P<.001）；胸部受累在男性中更为常见（P=.005）。年龄在 13 至 64 岁的女孩和女性乳房受累更常见（P=.01）。无论年龄大小，男性的病变部位分布均匀（P=.40）。90%（110/122 例接受治疗的患者）和 73%（90/123 例可评估的患者）分别开始了抗生素药物治疗和清创术。与非术后 PG 相比，术后 PG 与系统性疾病的相关性较低。常规开始抗生素药物治疗。常对受累部位进行清创，导致更多的伤口破裂。早期诊断可能预防并发症。
