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剖宫产术后坏死性筋膜炎导致经腹子宫切除术

Necrotizing Fasciitis Post-Cesarean Section Leading to Transabdominal Hysterectomy.

作者信息

Liang Alvina, Idowu Mary Boluwatife, Eskind Steven Joseph, Patel Soha S

机构信息

Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.

Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee.

出版信息

AJP Rep. 2024 Sep 30;14(3):e235-e238. doi: 10.1055/a-2414-7696. eCollection 2024 Jul.

Abstract

Necrotizing fasciitis (NF) is a rare but life-threatening disease characterized by rapidly spreading inflammation and subsequent necrosis of the fascial planes and surrounding tissues. Limited literature has described NF as involving an adjacent solid organ beyond fascial planes that has required its removal. We present a case of a 25-year-old white female who underwent a cesarean section and subsequently developed NF involving her uterus and abdominal wall that necessitated a total abdominal hysterectomy, serial surgical debridement of necrotic tissue, and wound vacuum assisted closure (VAC) placement. Her pathology report described her uterus infiltrated by polybacteria, confirming a diagnosis of NF. Despite NF's progressive nature and potential lethality, NF can be challenging to diagnose clinically due to a lack of pathognomonic signs and symptoms. However, early detection of NF with the aid of Laboratory Risk Indicator for Necrotizing Fasciitis score calculation using laboratory values such as white blood cell count, hemoglobin, sodium, glucose, serum creatinine, and C-reactive protein is critical for optimal patient outcomes. A multidisciplinary team approach is vital in treating these patients to debride necrotizing tissue and control the potential sequelae from the infection, particularly for postpartum patients.

摘要

坏死性筋膜炎(NF)是一种罕见但危及生命的疾病,其特征是筋膜平面和周围组织迅速蔓延的炎症及随后的坏死。仅有有限的文献描述过NF累及筋膜平面以外的相邻实体器官并需要将其切除的情况。我们报告一例25岁白人女性病例,该患者接受剖宫产术后发生了累及子宫和腹壁的NF,这需要进行全腹子宫切除术、对坏死组织进行系列外科清创以及放置伤口负压封闭引流(VAC)。她的病理报告显示其子宫被多种细菌浸润,确诊为NF。尽管NF具有进行性且有潜在致死性,但由于缺乏特异性的体征和症状,NF在临床上可能难以诊断。然而,借助坏死性筋膜炎实验室风险指标,利用白细胞计数、血红蛋白、钠、葡萄糖、血清肌酐和C反应蛋白等实验室值来计算得分,早期发现NF对于实现最佳患者预后至关重要。多学科团队方法对于治疗这些患者以清创坏死组织并控制感染的潜在后遗症至关重要,尤其是对于产后患者。

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本文引用的文献

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Impact of severe necrotizing fasciitis on quality of life in the Netherlands.严重坏死性筋膜炎对荷兰生活质量的影响。
Eur J Trauma Emerg Surg. 2022 Dec;48(6):4805-4811. doi: 10.1007/s00068-022-02011-z. Epub 2022 Jun 9.
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Necrotizing skin and soft-tissue infections in the intensive care unit.重症监护病房中的皮肤和软组织坏死性感染。
Clin Microbiol Infect. 2020 Jan;26(1):8-17. doi: 10.1016/j.cmi.2019.06.031. Epub 2019 Jul 5.

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