廣泛性Fournier's壞疽治療的經驗

Treatment of Extensive Fournier's Gangrene

Fournier's壞疽係會陰部一種迅速蔓延的壞死性筋膜炎，此病的典型特徵是會陰部猛然的發炎，且迅速擴展至陰莖，腹壁及大腿內側，由於蔓延迅速，並常造成全身性敗血症，因此死亡率相當高。廣泛性的Fournier's壞疽比局限性的Fournier's壞疽有較高的死亡率，敗血症是造成病患死亡最重要的因素，因此我們的治療原則是防止Fournier's壞疽的繼續蔓延，以及控制敗血症的進展。對於Fournier's壞疽，除了接受廣泛性的清創手術，廣效性之抗生素治療外，早期的結腸造口手術及高壓氧的輔助治療，也可能降低其死亡率。由於近年來壞死性筋膜炎的病例有增加的現象，而且不乏有延遲診斷及死亡的病例，藉此，本文提出3例我們治療廣泛性壞死筋膜炎經驗，顯示在經過及時正確治療後，是可以增加病人的存活率及縮短住院天數。

Fournier's gangrene is fulminant, the disease may occur without an apparent precipitating cause and follow a variety of clinical conditions. It is associated with severe systemic toxicity necrosis of the subcutaneous tissue and fascia and significant mortality rate. Although the treatment has improved the mortality rate is still hight. The mortality rate of Fournier's gangrene with extensive lesion has higher than that with localized lesions. Bacteremia and sepsis are the major factors of morality. Therefore, the treatment strategy is to prevent the spread of gangrene and to control the progress of sepsis. These includes extensive debridement and broad-spectrum antibiotic therapy. Besides, early colostomy and hyperbaric oxygen adjuvant treatment may also decrease the mortality rate. Due to recent increasing incidence, and occasional delayed diagnosis, we present our experience of three cases to show early and appropriate treatment might shorten the hospital stay and increase the survival rate.