Singh Ariana, Ahmed Kamran, Aydin Abdullatif, Khan Muhammad Shamim, Dasgupta Prokar
MRC Centre for Transplantation, King's College London; Department of Urology, Guy's and St. Thomas' NHS Foundation Trust - King's Health Partners, London.
Arch Ital Urol Androl. 2016 Oct 5;88(3):157-164. doi: 10.4081/aiua.2016.3.157.
Fournier's gangrene is a rare, necrotising fasciitis of the external genitalia, perineal or perianal regions. The disease has a higher incidence in males and risk factors for development include diabetes, HIV, alcoholism and other immune-compromised states. The aggressive disease process is associated with a high mortality rate of 20-30%. In addition, the increasing age and prevalence of diabetes in the population, begs the need for increased clinical awareness of Fournier's gangrene with emphasis on early diagnosis and management. This review aims to highlight the relevant research surrounding Fournier's gangrene, in particular the various prognostic indicators and management strategies.
A search was conducted on the MEDLINE database for all applicable research; clinical reviews, retrospective studies and case reports. In addition to which a search of the European Association of Urology, the British Association for Urological Surgeons and the British Medical Journal was conducted for the most recent recommendations.
Immediate broad-spectrum antibiotic therapy and urgent surgical debridement are the core managerial principles of Fournier's gangrene. The use of adjunctive therapies such as hyperbaric oxygen and vacuum assisted closure are supported in some aspects of the literature and disputed in others. The lack of randomized controlled studies limits the use of these potential additional therapies to patients unresponsive to conventional management. The value of unprocessed honey as a topical antimicrobial agent has been highlighted in the literature for small lesions in uncomplicated patients.
Fournier's gangrene is a urological emergency with a high mortality rate despite advances in the medical and surgical fields. The aggressive nature of the infection advocates the need for early recognition allowing immediate surgical intervention. The opposing results of available research as well as the lack of high quality evidence surrounding emergent therapies prevents their routine use in the management of Fournier's gangrene. The absence of a specific care pathway may hinder efficient management of Fournier's gangrene, thus based on current guidelines a management pathway is suggested.
福尼尔坏疽是一种发生于外生殖器、会阴或肛周区域的罕见坏死性筋膜炎。该疾病在男性中的发病率较高，其发病的危险因素包括糖尿病、HIV感染、酗酒及其他免疫功能低下状态。这种侵袭性疾病进程的死亡率高达20% - 30%。此外，随着人群年龄增长及糖尿病患病率上升，有必要提高对福尼尔坏疽的临床认识，重点在于早期诊断和治疗。本综述旨在突出围绕福尼尔坏疽的相关研究，尤其是各种预后指标和治疗策略。
在MEDLINE数据库中检索所有适用的研究；临床综述、回顾性研究和病例报告。此外，还检索了欧洲泌尿外科学会、英国泌尿外科医师协会和《英国医学杂志》以获取最新建议。
立即进行广谱抗生素治疗和紧急手术清创是福尼尔坏疽的核心治疗原则。高压氧和负压封闭引流等辅助治疗在一些文献中有支持依据，而在另一些文献中则存在争议。缺乏随机对照研究限制了这些潜在辅助治疗在对传统治疗无反应患者中的应用。未加工蜂蜜作为局部抗菌剂对无并发症患者小病灶的价值在文献中已得到强调。
尽管医学和外科领域取得了进展，但福尼尔坏疽仍是一种泌尿外科急症，死亡率较高。感染的侵袭性表明需要早期识别以便立即进行手术干预。现有研究结果相互矛盾，且围绕紧急治疗缺乏高质量证据，这使得它们无法常规用于福尼尔坏疽的治疗。缺乏特定的护理路径可能会阻碍福尼尔坏疽的有效管理，因此基于当前指南提出了一种管理路径。
