Department of Urology, University Hospital Rostock, Rostock, Germany,
Department of Urology, Asklepios Clinic St. Georg, Hamburg, Germany.
Urol Int. 2021;105(3-4):247-256. doi: 10.1159/000511615. Epub 2020 Dec 7.
Fournier's gangrene (FG) is a sporadic, life-threatening, necrotizing infection affecting the perineum, perineal region, and genitals. Hyperbaric oxygenation (HBO) improves tissue perfusion and promotes angiogenesis and collagen synthesis. Despite these positive effects of HBO, the indication and the effects on outcome as adjunct therapy in FG remain controversial. Consequently, we decided to perform a systematic review to compare the treatment of FG with or without the use of HBO as an adjunct therapy.
We performed a systematic review following the recommendations provided in the Cochrane Handbook of systematic Reviews and the PRISMA reporting guidelines. Due to the paucity of data and a suspected lack of randomized controlled trials, we considered all the available information for this systematic review.
The literature search for primary studies yielded 79 results. Finally, 13 studies were considered, which included a total of 376 patients with FG, of whom 202 received HBO therapy. Five of these studies had a retrospective case-control design. However, these 5 studies included a total of 319 patients; 145 of these patients were treated with adjunct HBO therapy. Overall, this leads to a mortality rate of 16.6% in the HBO group and 25.9% in the non-HBO group. Overall, risk of bias was assessed as moderate to high.
We conclude that despite the risk of bias, HBO has potential as an adjunct in FG treatment, but it is challenging to carry out further studies, mainly due to the rareness of FG and availability of HBO.
Fournier 坏疽（FG）是一种罕见的、危及生命的、坏死性感染，影响会阴、会阴区域和生殖器。高压氧治疗（HBO）可改善组织灌注，促进血管生成和胶原合成。尽管 HBO 有这些积极作用，但作为 FG 的辅助治疗的适应证和对结果的影响仍存在争议。因此，我们决定进行系统评价，比较 FG 治疗中是否使用 HBO 作为辅助治疗。
我们按照 Cochrane 系统评价手册和 PRISMA 报告指南的建议进行了系统评价。由于数据稀少且疑似缺乏随机对照试验，我们考虑了这项系统评价的所有可用信息。
对原始研究的文献检索产生了 79 个结果。最后，考虑了 13 项研究，这些研究共包括 376 例 FG 患者，其中 202 例接受了 HBO 治疗。其中 5 项研究具有回顾性病例对照设计。然而，这 5 项研究共包括 319 例患者；其中 145 例患者接受了辅助 HBO 治疗。总体而言，HBO 组的死亡率为 16.6%，非 HBO 组的死亡率为 25.9%。总体而言，偏倚风险评估为中度至高度。
尽管存在偏倚风险，但 HBO 作为 FG 治疗的辅助手段具有潜力，但由于 FG 的罕见性和 HBO 的可用性，进行进一步的研究具有挑战性。
