Email Alerts
RSS
Volume 40 Issue 10
Oct.  2024
Turn off MathJax
Article Contents
Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2024  >  40(10): 955-962
Zhu SB,Li DH,Liu DE,et al.Analysis of clinical characteristics and treatment of patients with perianal necrotizing fasciitis[J].Chin J Burns Wounds,2024,40(10):955-962.DOI: 10.3760/cma.j.cn501225-20231028-00143.
Citation: Zhu SB,Li DH,Liu DE,et al.Analysis of clinical characteristics and treatment of patients with perianal necrotizing fasciitis[J].Chin J Burns Wounds,2024,40(10):955-962.DOI: 10.3760/cma.j.cn501225-20231028-00143.
shu

Analysis of clinical characteristics and treatment of patients with perianal necrotizing fasciitis

doi: 10.3760/cma.j.cn501225-20231028-00143
  • 1.

    Department of Burn and Plastic Surgery (Wound Repair), Wuming Hospital Affiliated to Guangxi Medical University, Nanning 530100, China

  • 2.

    Department of Burn and Plastic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China

Funds:

Regional Science Foundation of National Natural Science Foundation of China 82260390

More Information
    Abstract
  •   Objective  To investigate the clinical characteristics and treatment of patients with perianal necrotizing fasciitis.  Methods  This study was a retrospective cohort study. Twenty patients with perianal necrotizing fasciitis who met the inclusion criteria were admitted to the Department of Burn and Plastic Surgery of the First Affiliated Hospital of Guangxi Medical University (hereinafter referred to as our department) from August 2013 to September 2023, including 19 males and 1 female, aged 24-74 (56±11) years. Based on the spreading route of perianal infection to the lower abdomen, the patients were divided into perianal-inguinal-lower abdominal wall group (12 cases) and perianal-pelvic cavity-retroperitoneal group (8 cases). The following clinical data were compared between the two groups of patients: general data, including gender, age, combined underlying diseases, blood glucose level and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score when admitted to our department, and laboratory risk indicator for necrotizing fasciitis (LRINEC) score when admitted to our department and at 14 d after admitted to our department; infection indicators when admitted to our department, including C-reactive protein level, white blood cell count, lymphocyte count, procalcitonin level, and lactic acid level; clinical outcome-related indicators, including time from onset to definite infection range, number of surgery, treatment in intensive care unit (ICU), length of hospital stay, treatment outcome, and recurrence of necrotizing fasciitis during follow-up; detection of pathogen and bacterial drug resistance in wound necrotic tissue specimen when admitted to our department.  Results  Compared with those in perianal-inguinal-lower abdominal wall group, the APACHE Ⅱ score and lactic acid level when admitted to our department and LRINEC score at 14 d after admitted to our department (with t values of -5.98, -5.01, and -2.86, respectively, P<0.05) and ICU treatment ratio (P<0.05) were significantly increased, the time from onset to definite infection range was significantly prolonged (Z=-3.75, P<0.05), and the number of surgery was significantly increased (Z=2.80, P<0.05) in patients in perianal-pelvic cavity-retroperitoneal group. There were no statistically significant differences in other data between the two groups of patients (P>0.05). Eighteen patients were cured, and no recurrence of perianal necrotizing fasciitis was observed during follow-up of 6 months in 18 cured patients. The main bacteria were Escherichia coli and Klebsiella pneumoniae, and the fungui were Aspergillus and Candida albicans detected in wound necrotic tissue specimens in two groups of patients when admitted to our department. The ratio of multiple drug resistance of bacteria in wound necrotic tissue specimens in perianal-pelvic cavity-retroperitoneal group of patients was significantly higher than that in perianal-inguinal-lower abdominal wall group (P<0.05).  Conclusions  Perianal necrotizing fasciitis can spread to the lower abdomen through two routes: the perianal-inguinal-lower abdominal wall route and the perianal-pelvic cavity-retroperitoneal route. The latter is more insidious in disease progression and more challenging in treatment. Establishing a mechanism of multi-disciplinary team diagnosis and treatment can achieve the goal of early diagnosis and precise treatment of perianal necrotizing fasciitis.

     

    • FullText(HTML)
  • loading
    • References(32)
  • [1]
    HuaC, UrbinaT, BoscR, et al. Necrotising soft-tissue infections [J]. Lancet Infect Dis, 2023, 23(3):e81-e94. DOI: 10.1016/S1473-3099(22)00583-7.
    [2]
    HysongAA,PoseySL,BlumDM,et al.Necrotizing fasciitis: pillaging the acute phase response[J].J Bone Joint Surg Am,2020,102(6):526-537.DOI: 10.2106/JBJS.19.00591.
    [3]
    Pinho-RibeiroFA,BaddalB,HaarsmaR,et al.Blocking neuronal signaling to immune cells treats Streptococcal invasive infection[J].Cell,2018,173(5):1083-1097.e22.DOI: 10.1016/j.cell.2018.04.006.
    [4]
    郑介飞,屠海霞,曹玉珏.综合治疗肛周坏死性筋膜炎十例[J].中华烧伤杂志,2019,35(4):311-313.DOI: 10.3760/cma.j.issn.1009-2587.2019.04.012.
    [5]
    宋达疆,李赞,周晓,等.会阴肿瘤切除术后缺损之皮瓣/肌皮瓣修复方法的选择和效果[J].中华烧伤杂志,2020,36(6):451-457.DOI: 10.3760/cma.j.cn501120-20190320-00129.
    [6]
    FisherJR,ConwayMJ,TakeshitaRT,et al.Necrotizing fasciitis. Importance of roentgenographic studies for soft-tissue gas[J].JAMA,1979,241(8):803-806.DOI: 10.1001/jama.241.8.803.
    [7]
    AllawF,WehbeS,KanjSS.Necrotizing fasciitis: an update on epidemiology, diagnostic methods, and treatment[J].Curr Opin Infect Dis,2024,37(2):105-111.DOI: 10.1097/QCO.0000000000000988.
    [8]
    FournierJA.Jean-Alfred Fournier 1832-1914. Gangrène foudroyante de la verge (overwhelming gangrene). Sem Med 1883[J].Dis Colon Rectum,1988,31(12):984-988.DOI: 10.1007/BF02554904.
    [9]
    TosunY,AkıncıO,KüçükHF.Risk factors for mortality in Fournier's gangrene of anorectal origin[J].Ulus Travma Acil Cerrahi Derg,2022,28(8):1128-1133.DOI: 10.14744/tjtes.2021.97866.
    [10]
    KiranRP.Fournier's gangrene: a review of 1726 cases[J].Br J Surg,2000,87(11):1596.DOI: 10.1046/j.1365-2168.2000.01679-9.x.
    [11]
    AshwathG,Kathiresan ManasijanE,Seelampatti PalanisamyL,et al.a clinical-anatomical-radiological study of extraperitoneal spaces: a case series[J].Cureus,2024,16(3):e56149.DOI: 10.7759/cureus.56149.
    [12]
    徐鹏,薛明宇,芮永军,等.载抗生素骨水泥治疗糖尿病足坏死性筋膜炎致小腿筋膜室综合征[J].中国组织工程研究,2024,28(17):2637-2641.DOI: 10.12307/2024.441.
    [13]
    郭晓峰,金柱成,邓鑫鑫,等.抗生素骨水泥联合负压封闭引流治疗糖尿病并发坏死性筋膜炎的临床效果[J].中华烧伤与创面修复杂志,2023,39(12):1158-1162.DOI: 10.3760/cma.j.cn501225-20231030-00151.
    [14]
    YamamuroR,HosokawaN,KatayamaM.Patient with liver cirrhosis presenting with necrotizing fasciitis due to Acinetobacter junii: a case report and literature review[J].J Infect Chemother,2020,26(2):308-311.DOI: 10.1016/j.jiac.2019.09.018.
    [15]
    ChingkoeCM,JahedA,LoretoMP,et al.Retroperitoneal fasciitis: spectrum of CT findings in the abdomen and pelvis[J].Radiographics,2015,35(4):1095-1107.DOI: 10.1148/rg.2015140071.
    [16]
    ChenY,HeJ,WuQ,et al.Prevalence and risk factors of exposure keratopathy among critically ill patients: a systematic review and meta-analysis[J].Nurs Open,2024,11(1):e2061.DOI: 10.1002/nop2.2061.
    [17]
    KimDH,KimSW,HwangSH.Application of the laboratory risk indicator for necrotizing fasciitis score to the head and neck: a systematic review and meta-analysis[J].ANZ J Surg,2022,92(7/8):1631-1637.DOI: 10.1111/ans.17459.
    [18]
    高秋芳,牛雪涛,马彬,等.股前外侧带蒂皮瓣修复坏死性筋膜炎所致会阴部皮肤软组织缺损的效果[J].中华烧伤杂志,2020,36(8):738-742.DOI: 10.3760/cma.j.cn501120-20190528-00257.
    [19]
    ChenLL,FasolkaB,TreacyC.Necrotizing fasciitis: a comprehensive review[J].Nursing,2020,50(9):34-40.DOI: 10.1097/01.NURSE.0000694752.85118.62.
    [20]
    李龙珠,李大伟,申传安,等. 负压封闭引流技术在四肢严重坏死性筋膜炎患者治疗中的应用[J]. 中华烧伤杂志,2015,31(2):98-101. DOI: 10.3760/cma.j.issn.1009-2587.2015.02.005.
    [21]
    赵海磊,赵晓慧,杨彬,等.综合治疗急性坏死性筋膜炎25例[J].中华烧伤杂志,2021,37(4):382-385.DOI: 10.3760/cma.j.cn501120-20200426-00238.
    [22]
    AhmadzadaS,RaoA,GhazaviH.Necrotizing fasciitis of the face: current concepts in cause, diagnosis and management[J].Curr Opin Otolaryngol Head Neck Surg,2022,30(4):270-275.DOI: 10.1097/MOO.0000000000000820.
    [23]
    中国医师协会肛肠医师分会临床指南工作委员会. 肛周坏死性筋膜炎临床诊治中国专家共识(2019年版)[J]. 中华胃肠外科杂志,2019,22(7):689-693.DOI: 10.3760/cma.j.issn.1671-0274.2019.07.017.
    [24]
    孔祥力,石凯,薛岩,等.Fournier坏疽的研究进展[J].中华烧伤杂志,2020,36(1):70-76.DOI: 10.3760/cma.j.issn.1009-2587.2020.01.014.
    [25]
    AkcanA,SözüerE,AkyildizH,et al.Necessity of preventive colostomy for Fournier's gangrene of the anorectal region[J].Ulus Travma Acil Cerrahi Derg,2009,15(4):342-346.
    [26]
    AmaranathanA,SahooAK,BarathiD,et al.Retroperitoneal necrotizing fasciitis masquerading as perianal abscess - rare and perilous[J].Cureus,2017,9(1):e982.DOI: 10.7759/cureus.982.
    [27]
    Ortega FerreteA,LópezE,Juez SáezLD,et al.Fournier's gangrene and fecal diversion. When, in which patients, and what type should I perform?[J].Langenbecks Arch Surg,2023,408(1):428.DOI: 10.1007/s00423-023-03137-3.
    [28]
    HuangS,ChenDC,PereraM,et al.Role of diverting colostomy and reconstruction in managing Fournier's gangrene-a narrative review[J].BJU Int,2024,134(4):534-540.DOI: 10.1111/bju.16365.
    [29]
    赵耀华,袁东亮,熊伟,等.双通路负压封闭引流治疗肛周坏死性筋膜炎六例[J].中华烧伤杂志,2016,32(12):730-732.DOI: 10.3760/cma.j.issn.1009-2587.2016.12.006.
    [30]
    TaoXC,HuDC,YinLX,et al.Necrotizing fasciitis of cryptoglandular infection treated with multiple incisions and thread-dragging therapy: a case report[J].World J Clin Cases,2021,9(28):8537-8544.DOI: 10.12998/wjcc.v9.i28.8537.
    [31]
    AlyanakA,CakiciOU,TurkmenYA.Skin-sparing approach in the management of Fournier's gangrene: the initial histological evidence and results of a tertiary health-care center[J].ANZ J Surg,2022,92(1/2):128-131.DOI: 10.1111/ans.17387.
    [32]
    Bin MosaM,AlyamiA,AbumelhaS,et al.Successful laparoscopic management of retroperitoneal necrotizing fasciitis: a case report[J].Cureus,2021,13(10):e18677.DOI: 10.7759/cureus.18677.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(3)  / Tables(4)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (75) PDF downloads(11) Cited by()
    Proportional views
    Related

    Copyright © Chinese Journal of Burns京ICP备07035254号-14

    E-mail：shaoshangzazhi@163.com

    Website：https://zhsszz.xml-journal.net/

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return