多学科联合治疗会阴肛周脓肿合并坏死性筋膜炎的体会

Report of Multidisciplinary Treatment of Perineal and Perianal Abscess with Necrotizing Fasciitis

摘要: 目的：探讨多学科联合治疗会阴肛周脓肿合并坏死性筋膜炎的治疗体会。方法：对17例严重会阴肛周脓肿合并坏死性筋膜炎患者，采用以肛肠外科为主体，多学科联合治疗的模式，在行早期清创手术的同时，使用足量广谱抗生素，联合中药使用及艾灸治疗等方法，提高生存率。结果：坏死性筋膜炎引起的重症感染早期被有效控制，患者当中1例死亡，1例自动出院，13例出院随诊换药治疗，2例转回当地医院换药。结论：对于严重会阴肛周脓肿合并坏死性筋膜炎患者，只有通过多学科综合治疗，发挥各自专业特长，遵循损害控制的原则，在积极治疗多发伤的同时，早期评估、早期使用有效的抗生素、早期积极清创、充分引流，结合中医中药，能有效提高抢救成功率，降低并发症的发生率。

Abstract: Purpose: The case report of multidisciplinary treatment of perineal and perianal abscess with necrotizing fasciitis. Methods: Apply anorectal surgery and multidisciplinary as the main body of the therapy of 17 patients with severe perineal and perianal abscess, meanwhile, use Chinese traditional medicine (include but not limit in moxibustion) as auxiliary to increase the survival rate. Results: Severe cases of infections, caused by necrotizing fasciitis, are controlled effectively in the early stage. The prognosis is well evaluated in the late stage (supported by APII score). Among all the patients, one death; one discharged automatically; thirteen were discharged for follow-up treatment; two were transferred back to the local hospital for dressing change. Conclusion: For patients with severe perineal and perianal abscess complicated with necrotizing fasciitis, only through multidisciplinary comprehensive treatment, give full play to their respective professional expertise, follow the principle of damage control, while actively treating multiple injuries, early evaluation, early use of effective antibiotics, early active debridement, full drainage, combined with traditional Chinese medicine, can effectively improve the success rate of rescue and reduce the incidence of complications.