Chevallier D, Amiel J, Michetti C, Birtwisle Y, Richelme H, Toubol J
J Urol (Paris). 1987;93(3):145-50.
The authors report on 13 cases of gangrene of the perineum. Eight of the patients presented with a pre-existing infectious or tumoral anorectal lesion. In two cases, gangrene was a complication of a surgically treated prostatic pathology; two other patients had Fournier's disease. The last case was termed "spontaneous" as no causative factor was found. The unexpected recrudescence of this pathology, its severe nature, our limited knowledge of the pathogenic factors involved, and the difficulties encountered in treatment make analysis of this series of cases particularly interesting; moreover, despite the apparent etiological disparity of these observations, there were common anatomic, bacteriologic, and therapeutic elements. As concerns treatment, emphasis is placed on three points: prime role of surgery, the only means of obtaining precise information on lesions, broad indications for bypass colostomy, value of treatment with hyperbaric oxygen. The mortality rate remains high: 4 of the 13 patients died.
作者报告了13例会阴坏疽病例。其中8例患者先前存在感染性或肿瘤性肛肠病变。2例坏疽是手术治疗前列腺疾病的并发症；另外2例患者患有福尼尔氏坏疽。最后1例被称为“自发性”，因为未发现致病因素。这种病理状况意外复发，病情严重，我们对相关致病因素了解有限，且治疗中遇到困难，使得对这一系列病例的分析格外有趣；此外，尽管这些观察结果的病因明显不同，但存在共同的解剖学、细菌学和治疗因素。关于治疗，重点强调三点：手术的首要作用，这是获取病变精确信息的唯一手段；结肠造口旁路术的广泛适应证；高压氧治疗的价值。死亡率仍然很高：13例患者中有4例死亡。
