Rosenberg P H, Shuck J M, Tempest B D, Reed W P
Ann Surg. 1978 Apr;187(4):430-4. doi: 10.1097/00000658-197804000-00015.
Nine patients with necrotizing soft tissue infection of the perineum and adjacent areas developed following perirectal absecess, retroperitoneal infection, local trauma or apparently spontaneously. Skin changes and crepitus were often present but severe local pain was the only indication of infection in three patients. Repeated surgery or in one case, a necropsy, were required to uncover the extensive, dissecting, purulent and necrotizing subcutaneous process. Myonecrosis had occurred in three cases. Operation was often delayed for several days because of the difficulty in recognizing the presence of infection or because the urgency for treating an already apparent infection was not appreciated. The mortality was high (5/9 cases). The bacterial isolates were predominantly of a mixed aerobic-anaerobic nature. Needle aspiration of suspicious areas, even where classic signs of inflammation are lacking and Gram staining of exudate are valuable procedures for diagnosis and institution of appropriate presumptive antibiotic treatment. Thorough surgical exploration and debridement must be performed promptly to maximize chances for survival.
9例会阴及邻近区域坏死性软组织感染患者继发于直肠周围脓肿、腹膜后感染、局部创伤或病因不明。常出现皮肤改变和皮下捻发音，但有3例患者仅以严重局部疼痛作为感染的唯一表现。需要反复手术，其中1例需尸检，以发现广泛的、呈蔓延性的、化脓性和坏死性皮下病变。3例发生了肌坏死。由于难以识别感染的存在或未意识到已明确感染的紧迫性，手术常延迟数天。死亡率很高（9例中有5例）。分离出的细菌主要为需氧菌和厌氧菌混合感染。对可疑区域进行针吸，即使缺乏典型炎症体征且对渗出物进行革兰氏染色，也是诊断和开始适当经验性抗生素治疗的重要方法。必须立即进行彻底的手术探查和清创，以最大程度提高存活几率。
