佛尼爾氏壞疽併發症的預測指標及早期手術介入的角色-單一醫學中心的十年經驗
李宗叡、黃志平、陳汶吉、陳國樑、謝博帆、連啟舜、張議徽、蕭博任
中國醫藥大學附設醫院 泌尿部
Risk factors for the morbidity of Fournier’s gangrene and the role of early debridement in reducing the mortality and morbidity—a single center experience
Tzung-Ruei Li, Chi-Ping Huang, Wen-Chi Chen, Kuo-Liang Chen, Chi-Shuen Lien, Yi-Huei Chang,
Po-Jen Hsiao
Department of Urology, China Medical University Hospital, Taichung, Taiwan
Purpose:
Fournier’s gangrene is a rapidly progressive and life-threatening disease. The mortality rate could reach to 40%. Several studies had revealed the risk factors and the possible early management could benefit survival. We aim to identify the risk factors for the morbidity and mortality in patients with Fournier’s gangrene, and the role of early debridement in our hospital with ten years cases.
Materials and Methods:
This retrospective study recruited 104 patients who was diagnosed as Fournier’s gangrene from Jan.2012 to Jan.2022 in our hospital. Patients who initially went to emergency room, and then received the first debridement were included. We analyzed the comorbidity, laboratory parameters for the morbidity and mortality. We then further performed the subgroup analysis of time (hours) from emergency room (ER) to operation (OP) between the patients who had morbidity and the patients who did not have. All the statistical analysis was performed with SPSS 25.0.
Results:
Of all the 104 patients, 10 (9.6%) patients died. 29 (27.9%) patients had further morbidity (mortality, septic shock, acute renal failure, pulmonary edema, delayed bleeding…). Diabetic mellitus was the most common comorbidity (57.7%). Between the morbidity group and free-morbidity group, there were significant differences in Fournier’s gangrene severity index (FGSI) (7.17±3.86; 4.47±3.05, p=0.002), creatine level (3.16±2.64, 1.75±1.49, p=0.01), ER to OP hours (58.83±70.75, 20.02±27.00. p= 0.007) and the comorbidity of liver cirrhosis(p=0.003).
We then investigated 57 patients with FGSI≧5, and further subdivided to early debridement group (n=39) and late debridement group (n=18) as a cut-off interval time of 14 hours. There was no difference in the FGSI or other parameters between the above groups. The mortality and morbidity rate showed 28.21% in early debridement group, and 55.56% in late debridement group (p=0.047).
Conclusions:
The morbidity rate in our center was about 27.9%. Higher FGSI, creatine level and liver cirrhosis were the prognostic factors for the morbidity. Furthermore, early surgery within 14 hours would significantly decrease the morbidity rate about 27% with patients of immediate and high risk.