Goepfert A R, Guinn D A, Andrews W W, Hauth J C
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA.
Obstet Gynecol. 1997 Mar;89(3):409-12. doi: 10.1016/S0029-7844(96)00511-X.
To review our experience with the diagnosis and management of necrotizing fasciitis after cesarean delivery.
We reviewed medical records of women with serious post-cesarean wound infections at the University of Alabama at Birmingham between 1987 and 1994 to identify women with necrotizing fasciitis. The diagnosis of necrotizing fasciitis required intraoperative identification of necrotic fascia in febrile women undergoing post-cesarean wound debridement.
During the study period, 5048 women had cesarean deliveries, nine of which were complicated by necrotizing fasciitis. The mean (+/-standard deviation) maternal age was 27 +/- 6 years, and the mean maternal weight was 199 +/- 64 lb. None of the patients had insulin-dependent diabetes mellitus, and none had known peripheral vascular disease. There were no intraoperative complications at cesarean delivery. The mean time from cesarean delivery to the diagnosis of necrotizing fasciitis and reoperation was 10 +/- 4 days (range 5-17). All patients had surgical debridement upon consideration of the diagnosis, and all received broad-spectrum antimicrobial therapy. Results of wound cultures were available in seven of the women, and all seven were found to have polymicrobial infections. There were two mortalities, one as a result of metastatic breast cancer and another with complications of sepsis.
Necrotizing fasciitis is infrequent (1.8 per 1000 women) after cesarean delivery at our institution, but it does result in appreciable morbidity and mortality.
回顾我们在剖宫产术后坏死性筋膜炎诊断和处理方面的经验。
我们回顾了1987年至1994年期间在阿拉巴马大学伯明翰分校有严重剖宫产术后伤口感染的女性的病历，以确定患有坏死性筋膜炎的女性。坏死性筋膜炎的诊断需要在接受剖宫产术后伤口清创的发热女性中术中识别出坏死的筋膜。
在研究期间，5048名女性进行了剖宫产，其中9例并发坏死性筋膜炎。产妇平均年龄（±标准差）为27±6岁，平均体重为199±64磅。所有患者均无胰岛素依赖型糖尿病，也无已知的外周血管疾病。剖宫产术中无并发症。从剖宫产到诊断坏死性筋膜炎并再次手术的平均时间为10±4天（范围5 - 17天）。所有患者一经考虑诊断即接受手术清创，均接受了广谱抗菌治疗。7名女性有伤口培养结果，所有7名患者均发现有混合菌感染。有2例死亡，1例死于转移性乳腺癌，另1例死于败血症并发症。
在我们机构，剖宫产术后坏死性筋膜炎并不常见（每1000名女性中有1.8例），但确实会导致明显的发病率和死亡率。
