到院後十五小時內手術治療對佛尼爾氏壞疽有存活效益
林宗彥、 歐建慧、楊文宏、唐一清、鄭鴻琳、
蔡育賢、鄭裕生、陳奕宏、林永明
國立成功大學附設醫院斗六分院泌尿科、國立成功大學附設醫院泌尿部
Early surgical intervention within 15 hours results in survival benefit in Patients with fournier’s gangrene
Tsung-Yen Lina、Chien-Hui Oub、Wen-Horng Yangb、Yat-Ching Tongb、Hong-Lin Chengb、Yuh-Shyan Tsaib、Yu-Sheng Chengb、I-Hung Chenga、Yung-Ming Linb
aDivision of Urology, Department of Surgery, National Cheng Kung University Hospital Dou-Liou Branch, bDepartment of Urology, Medical College and Hospital, National Cheng-Kung University, Tainan, Taiwan
Abstract
Purpose: Fournier’s gangrene (FG) is a life-threatening disease and the reported mortality rates range from 7.5 to 45%. Given the high mortality rate in those patients, emergent surgical intervention is always needed. To date, only a handful of the studies explored the effect of intervention time on disease survival. The aim of this study is to determine the optimal time for surgical intervention, which might provide better prognosis.
Materials and Methods: From 1979 to 2015, a total of 95 patients diagnosed as FG in National Cheng Kung University Hospital were retrospectively reviewed. Patients’ demographics, laboratory parameters at initial diagnosis, Fournier’s gangrene severity index (FGSI) and simplified FGSI, time interval between the time of arriving emergency room (ER) and the time of starting surgery were recorded. All of the patients received aggressive surgical intervention. The patients were divided into survival and non-survival groups, and the time interval between the two groups was analyzed. A cut-off time interval was then used to subdivide our patients into early and delayed intervention groups. All parameters were compared between the two groups.
Results: Based on simplified FGSI, the mortality rate was 0% in score 0, 5.88% in score 1, 6.25% in score 2, 30.77% in score 3, 28.57% in score 4, 40% in score 5, 60% in score 6, 100% in score >7. Thirty patients with score between 3 and 6 were further investigated. The mean time interval between ER and OR in survivors (917.11 ± 1008.68 mins) was significant lower than non-survivors (1379.55 ± 903.9 mins) (P = 0.00). Then we defined 15 hours as cut-off time interval and those 30 patients were subdivided into early (n = 17) and delayed (n = 13) groups. Basic characteristics, laboratory parameter at initial diagnosis, FGSI and simplified FGSI were not significantly different between these two groups. The mortality rate was significantly lower in early intervention group (17.65%) compared to delayed group (61.54%) (P = 0.034).
Conclusions: Early surgical intervention within 15 hours can decrease mortality rate up to 44% in selected patients of Fournier’s gangrene who had relatively intermediate risk of mortality.