Le Fouler A, Hamy A, Barbieux J, Souday V, Bigot P, Le Naoures P, Jaouen R, Brochard C, Venara Aurélien
Department of Digestive and Endocrinal Surgery, CHU Angers, 4 rue Larrey, 49933, Angers, France.
LUNAM, University of Angers, Angers, France.
Int J Colorectal Dis. 2018 May;33(5):589-592. doi: 10.1007/s00384-018-2999-5. Epub 2018 Mar 2.
For survivors of perineal gangrene (PG), quality of life and functional prognosis of pelvic functions are probably overestimated. The aim of this study was to report long-term anal and urinary sphincter dysfunctions, sexual sequelae, and patients' quality of life after treatment of perineal gangrene.
This retrospective observational study was conducted in one university hospital over 16 years. Seventy-three patients experienced PG; 22 were subject to long-term follow-up. Three questionnaires were sent to patients to assess pelvic dysfunction and quality of life: the GIQLI, the Cleveland Incontinence Score, and the USP score for urinary dysfunction. Sexual sequelae were considered if orchiectomy or penile resection for male patients and vulvar resection for female patients were performed.
Of the 72 patients included, seven died before discharge (9.7%) and at least 14 died during follow-up (19.4%), despite a mean age of 62 years (± 13). Among the surviving patients, seven experienced an alteration of their quality of life (44%) (GIQLI < 96). Six patients still had a colostomy, and among the remaining patients, 11 experienced minimal to mild incontinence (68.7%), while one experienced constipation (6.2%). One patient suffered from urinary incontinence (4.5%), and six suffered from dysuria (27.3%). Three male patients (14%) underwent an orchiectomy, and one female patient (100%) underwent a vulvar resection.
PG leads to a high rate of anal and urinary dysfunctions. Urinary dysfunctions are taken into account and treated; however, anal incontinence is not investigated even though it could lead to decreased quality of life.
对于会阴坏疽（PG）幸存者，盆腔功能的生活质量和功能预后可能被高估。本研究的目的是报告会阴坏疽治疗后的长期肛门和尿道括约肌功能障碍、性后遗症以及患者的生活质量。
这项回顾性观察研究在一家大学医院进行了16年。73例患者经历了会阴坏疽；22例接受长期随访。向患者发送了三份问卷以评估盆腔功能障碍和生活质量：胃肠道生活质量指数（GIQLI）、克利夫兰失禁评分以及尿道功能障碍的美国泌尿学会（USP）评分。如果男性患者进行了睾丸切除术或阴茎切除术，女性患者进行了外阴切除术，则考虑性后遗症。
纳入的72例患者中，7例在出院前死亡（9.7%），随访期间至少14例死亡（19.4%），尽管平均年龄为62岁（±13）。在存活患者中，7例生活质量发生改变（44%）（GIQLI<96）。6例患者仍有结肠造口术，其余患者中，11例有轻度至中度失禁（68.7%），1例有便秘（6.2%）。1例患者有尿失禁（4.5%），6例有排尿困难（27.3%）。3例男性患者（14%）进行了睾丸切除术，1例女性患者（100%）进行了外阴切除术。
会阴坏疽导致肛门和尿道功能障碍的发生率很高。尿道功能障碍得到了重视和治疗；然而，尽管肛门失禁可能导致生活质量下降，但并未对其进行调查。
