University of New South Wales, Sydney, Australia.
Bankstown-Lidcombe Hospital, Sydney, NSW, Australia.
Langenbecks Arch Surg. 2021 Dec;406(8):2581-2590. doi: 10.1007/s00423-021-02175-z. Epub 2021 Apr 16.
Fournier's gangrene (FG) is a rare potentially lethal necrotising infection of the perineum. While the gold standard management is early and aggressive surgical debridement, the evidence in the literature is unclear as to the role and outcomes of diversional stoma.
A systematic review was conducted to identify studies investigating the relationship between stoma formation and FG. Meta-analyses were performed using a random-effects model.
Twenty-seven studies (n=1482) were included. There was no significant difference in disease severity scores between the stoma and no stoma groups. Mortality rate was significantly higher in patients who required diversional stoma (OR 1.71, 95% CI 1.13-2.59, p=0.01). Significantly more surgical procedures were performed on patients who underwent stoma formation, and the total hospital cost was also higher in this group. This study may have been limited by bias in patients with more fulminant course or sphincter damage requiring stoma as a medical necessity.
These findings suggest that the use of diversional stoma in FG is a predictor of poor outcomes. This study demonstrated that mortality rate remained high and a diversional stoma did not reduce risk of mortality as suggested by smaller case series. Its use should therefore be individualised based on disease severity and sphincter damage.
Fournier 坏疽（FG）是一种罕见的会导致会阴坏死性感染的潜在致命性疾病。虽然早期积极的外科清创术是金标准治疗方法，但文献中的证据并不清楚造口术在其中的作用和结果。
进行了系统评价，以确定研究 FG 与造口术之间关系的研究。使用随机效应模型进行荟萃分析。
共纳入 27 项研究（n=1482）。有造口组和无造口组之间的疾病严重程度评分无显著差异。需要造口术的患者死亡率显著更高（OR 1.71，95%CI 1.13-2.59，p=0.01）。接受造口术的患者接受了更多的手术，并且该组的总住院费用也更高。这项研究可能受到更暴发性病程或括约肌损伤的患者的偏倚影响，这些患者需要造口作为医疗必需。
这些发现表明，FG 中使用造口术是不良结局的预测因素。本研究表明，死亡率仍然很高，而且造口术并不能像较小的病例系列所表明的那样降低死亡率的风险。因此，应根据疾病严重程度和括约肌损伤来个体化使用。
