Diagnosis and Treatment of Necrotizing Fasciitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 吴昕 , 马志强 ,  于健春 , 康维明 , 叶欣 , 闫超

中国医学科学院北京协和医学院北京协和医院基本外科（北京 100730）;

Corresponding author：

于健春, Email: yu-jch@163.com

Keywords：

坏死性筋膜炎; 诊断; 清创术

DOI：

10.7507/1007-9424.20140307

Video：

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目的总结坏死性筋膜炎的特点和治疗方法。方法回顾性分析北京协和医院2000年2月至2014年3月期间所收治的20例坏死性筋膜炎病例的临床资料。结果 20例患者中男15例，女5例，男女比例3:1；发病年龄（52.3±11.0）岁（39～76岁）；病变部位双下肢11例，肛周7例，腹部切口1例，颈部1例。15例存在合并症，其中合并糖尿病7例。共18例患者接受手术，行1次手术者6例，2次及以上手术者12例，其中手术次数最多者达21次；另有1例患者因病重无手术机会而死亡，1例患者放弃抢救。共10例患者接受输血治疗。20例患者中好转13例（65%），转院2例（10%），死亡或放弃抢救治疗5例（25%）。结论坏死性筋膜炎进展迅速，早期诊断较难，死亡率较高。彻底清创是最重要的治疗手段，多数患者需要多次手术来控制疾病的进展。

Citation： 吴昕, 马志强, 于健春, 康维明, 叶欣, 闫超. Diagnosis and Treatment of Necrotizing Fasciitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(10): 1289-1291. doi: 10.7507/1007-9424.20140307 Copy

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5.	Dufel S, Martino M. Simple cellulitis or a more serious infection?[J]. J Fam Pract, 2006, 55(5):396-400.
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7.	Zaba R, Grzybowski A, Prokop J, et al. Fournier's gangrene:historical survey, current status, and case description[J]. Med Sci Monit, 2009, 15(2):CS34-CS39.
8.	Ayestaray B, Dudrap E, Chartaux E, et al. Necrotizing pyod-erma gangrenosum:an unusual differential diagnosis of necrotizing fasciitis[J]. J Plast Reconstr Aesthet Surg, 2010, 63(8):e655-e658.
9.	Barr KL, Chhatwal HK, Wesson SK, et al. Pyoderma gangrenosum masquerading as necrotizing fasciitis[J]. Am J Otolaryngol, 2009, 30(4):273-276.
10.	Sarani B, Strong M, Pascual J, et al. Necrotizing fasciitis:current concepts and reviews of the literature[J]. J Am Coll Surg, 2009, 208(2):279-288.
11.	Al-Waili NS, Butler GJ, Lee BY, et al. Possible application of hyperbaric oxygen technology in the management of urogenital and renal diseases[J]. J Med Eng Technol, 2009, 33(7):507-515.
12.	Tucci G, Amabile D, Cadeddu F, et al. Fournier's gangrene wound therapy:our experience using VAC device[J]. Langenbecks Arch Surg, 2009, 394(4):759-760;author reply 757-758.
13.	Sroczyński M, Sebastian M, Rudnicki J, et al. A complex approach to the treatment of Fournier's gangrene[J]. Adv Clin Exp Med, 2013, 22(1):131-135.
14.	Altarac S, Katušin D, Crnica S, et al. Fournier's gangrene:etiology and outcome analysis of 41 patients[J]. Urol Int, 2012, 88(3):289-293.
15.	Uluğ M, Gedik E, Girgin S, et al. The evaluation of microbiology and Fournier's gangrene severity index in 27 patients[J]. Int J Infect Dis, 2009, 13(6):e424-e430.

1. Morgan MS. Diagnosis and management of necrotizing fasciitis:a multiparametric approach[J]. J Hosp Infect, 2010, 75(4):249-257.
2. Ripley DL. Necrotizing fasciitis[J]. Prim Care Update Ob Gyns, 2000, 7(4):142-147.
3. Koukouras D, Kallidonis P, Panagopoulos C, et al. Fournier's gangrene, a urologic and surgical emergency:presentation of a multi-institutional experience with 45 cases[J]. Urol Int, 2011, 86(2):167-172.
4. Sorensen MD, Krieger JN, Rivara FP, et al. Fournier's Gangrene:population based epidemiology and outcomes[J]. J Urol, 2009, 181(5):2120-2126.
5. Dufel S, Martino M. Simple cellulitis or a more serious infection?[J]. J Fam Pract, 2006, 55(5):396-400.
6. Lamagni TL, Neal S, Keshishian C, et al. Severe Streptococcus pyogenes infections, United Kingdom, 2003-2004[J]. Emerg Infect Dis, 2008, 14(2):202-209.
7. Zaba R, Grzybowski A, Prokop J, et al. Fournier's gangrene:historical survey, current status, and case description[J]. Med Sci Monit, 2009, 15(2):CS34-CS39.
8. Ayestaray B, Dudrap E, Chartaux E, et al. Necrotizing pyod-erma gangrenosum:an unusual differential diagnosis of necrotizing fasciitis[J]. J Plast Reconstr Aesthet Surg, 2010, 63(8):e655-e658.
9. Barr KL, Chhatwal HK, Wesson SK, et al. Pyoderma gangrenosum masquerading as necrotizing fasciitis[J]. Am J Otolaryngol, 2009, 30(4):273-276.
10. Sarani B, Strong M, Pascual J, et al. Necrotizing fasciitis:current concepts and reviews of the literature[J]. J Am Coll Surg, 2009, 208(2):279-288.
11. Al-Waili NS, Butler GJ, Lee BY, et al. Possible application of hyperbaric oxygen technology in the management of urogenital and renal diseases[J]. J Med Eng Technol, 2009, 33(7):507-515.
12. Tucci G, Amabile D, Cadeddu F, et al. Fournier's gangrene wound therapy:our experience using VAC device[J]. Langenbecks Arch Surg, 2009, 394(4):759-760;author reply 757-758.
13. Sroczyński M, Sebastian M, Rudnicki J, et al. A complex approach to the treatment of Fournier's gangrene[J]. Adv Clin Exp Med, 2013, 22(1):131-135.
14. Altarac S, Katušin D, Crnica S, et al. Fournier's gangrene:etiology and outcome analysis of 41 patients[J]. Urol Int, 2012, 88(3):289-293.
15. Uluğ M, Gedik E, Girgin S, et al. The evaluation of microbiology and Fournier's gangrene severity index in 27 patients[J]. Int J Infect Dis, 2009, 13(6):e424-e430.

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Diagnosis and Treatment of Necrotizing Fasciitis

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