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NEJM：福尼尔坏疽-案例报道

2017-03-23 xing.T MedSci原创

福尼尔坏疽糖尿病会阴
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福尼尔坏疽是一种罕见的、危及生命的暴发性感染。老年男性以及糖尿病和慢性酒精使用障碍的男性发生福尼尔坏疽的风险增加。

患者为一名46岁的男子，患有血糖控制不佳的2型糖尿病和酒精性肝病，因阴囊及肛周区疼痛肿胀而到急诊就诊。

其体温为37.7°C，脉搏每分钟跳动130次，他的血压为97/61mmHg。体格检查在阴囊和会阴部发现显著的坏死样组织，有硬结及捻发音区（如图A）。计算机断层扫描发现阴囊、肛周筋膜部位有皮下气肿，还可以看到空气存在于直肠筋膜和直肠壁（图B，箭头所示）。诊断为福尼尔坏疽，或会阴坏死性筋膜炎。

福尼尔坏疽是一种罕见的、危及生命的暴发性感染。老年男性以及糖尿病和慢性酒精使用障碍的男性发生福尼尔坏疽的风险增加。

该患者接受腹腔镜辅助下经腹会阴切除术。病理分析发现坏死组织内有多个充满气体的口袋，并有中性粒细胞浸润。除手术外，患者接受液体复苏和广谱抗生素治疗。术后约3周，行皮肤移植再造会阴再造术。病人接受永久性结肠造口术后出院回家。

原始出处：

Chih-Sheng Huang. Fournier’s Gangrene.N Engl J Med 2017; 376:1158March 23, 2017. http://www.nejm.org/doi/full/10.1056/NEJMicm1609306

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    2017-10-28 chenwq16

    #福尼尔坏疽#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1649114, encodeId=c590164911436, content=<a href='/topic/show?id=9f1be4666cf' target=_blank style='color:#2F92EE;'>#福尼尔坏疽#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74666, encryptionId=9f1be4666cf, topicName=福尼尔坏疽)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad5d23746142, createdName=chenwq16, createdTime=Sat Oct 28 01:15:00 CST 2017, time=2017-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182292, encodeId=6f3518229226, content=太恐怖了！！！！, beContent=null, objectType=article, channel=null, level=null, likeNumber=163, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160914/IMG57D82E721DB581755.jpg, createdBy=4fc81933929, createdName=明天会更好！, createdTime=Fri Mar 24 01:02:58 CST 2017, time=2017-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182180, encodeId=becf182180fd, content=天呐，好恐怖啊！…………, beContent=null, objectType=article, channel=null, level=null, likeNumber=164, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=335e1961097, createdName=1e136eebm36(暂无匿称), createdTime=Thu Mar 23 13:11:43 CST 2017, time=2017-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182165, encodeId=f46518216556, content=学习了！！！, beContent=null, objectType=article, channel=null, level=null, likeNumber=174, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160914/IMG57D82E721DB581755.jpg, createdBy=4fc81933929, createdName=明天会更好！, createdTime=Thu Mar 23 12:17:14 CST 2017, time=2017-03-23, status=1, ipAttribution=)]
    2017-03-24 明天会更好！

    太恐怖了！！！！

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1649114, encodeId=c590164911436, content=<a href='/topic/show?id=9f1be4666cf' target=_blank style='color:#2F92EE;'>#福尼尔坏疽#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74666, encryptionId=9f1be4666cf, topicName=福尼尔坏疽)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad5d23746142, createdName=chenwq16, createdTime=Sat Oct 28 01:15:00 CST 2017, time=2017-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182292, encodeId=6f3518229226, content=太恐怖了！！！！, beContent=null, objectType=article, channel=null, level=null, likeNumber=163, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160914/IMG57D82E721DB581755.jpg, createdBy=4fc81933929, createdName=明天会更好！, createdTime=Fri Mar 24 01:02:58 CST 2017, time=2017-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182180, encodeId=becf182180fd, content=天呐，好恐怖啊！…………, beContent=null, objectType=article, channel=null, level=null, likeNumber=164, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=335e1961097, createdName=1e136eebm36(暂无匿称), createdTime=Thu Mar 23 13:11:43 CST 2017, time=2017-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182165, encodeId=f46518216556, content=学习了！！！, beContent=null, objectType=article, channel=null, level=null, likeNumber=174, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160914/IMG57D82E721DB581755.jpg, createdBy=4fc81933929, createdName=明天会更好！, createdTime=Thu Mar 23 12:17:14 CST 2017, time=2017-03-23, status=1, ipAttribution=)]
    2017-03-23 1e136eebm36(暂无匿称)

    天呐，好恐怖啊！…………

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1649114, encodeId=c590164911436, content=<a href='/topic/show?id=9f1be4666cf' target=_blank style='color:#2F92EE;'>#福尼尔坏疽#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74666, encryptionId=9f1be4666cf, topicName=福尼尔坏疽)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad5d23746142, createdName=chenwq16, createdTime=Sat Oct 28 01:15:00 CST 2017, time=2017-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182292, encodeId=6f3518229226, content=太恐怖了！！！！, beContent=null, objectType=article, channel=null, level=null, likeNumber=163, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160914/IMG57D82E721DB581755.jpg, createdBy=4fc81933929, createdName=明天会更好！, createdTime=Fri Mar 24 01:02:58 CST 2017, time=2017-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182180, encodeId=becf182180fd, content=天呐，好恐怖啊！…………, beContent=null, objectType=article, channel=null, level=null, likeNumber=164, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=335e1961097, createdName=1e136eebm36(暂无匿称), createdTime=Thu Mar 23 13:11:43 CST 2017, time=2017-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182165, encodeId=f46518216556, content=学习了！！！, beContent=null, objectType=article, channel=null, level=null, likeNumber=174, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160914/IMG57D82E721DB581755.jpg, createdBy=4fc81933929, createdName=明天会更好！, createdTime=Thu Mar 23 12:17:14 CST 2017, time=2017-03-23, status=1, ipAttribution=)]
    2017-03-23 明天会更好！

    学习了！！！

    0

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