| Objective:By retrospectively analyzing the clinical data of hospitalized patients with Fournier gangrene,the clinical characteristics,diagnosis,treatment and the prognostic factors of this disease were discussed,owning to provide reference for the diagnosis and treatment of Fournier gangrene.Methods:Reviewing the clinical data of 50 patients with Fournier gangrene admitted to the First Hospital of Jilin University,from 2008.01-2020.12,with necrotizing fasciitis as the primary diagnosis.The following basic information and data were collected,including clinical data:Demographic data included variables:sex,age(year),residence statu;marriage statu;The disease data on admission included:temperature(℃),heart rate(times per minute);diabetes mellitus,renal insufficiency,perianal disease,urinary tract disease,shock,cancer,wound site,length of hospital stay(day),hospitalization cost(ten thousands yuan);auxiliary examination admission information:wound secretion bacteria and fungus culture results,albumin(g/L),white blood cell count(10 ~9/L),neutrophil percentage(%),hemoglobin levels(g/L),red blood cell volume(%),creatinine(umol/L),sodium(mmol/L),potassium(mmol/L),c-reactive protein(mg/L),blood(mmol/L),and gluicuse(tendency/L).Hospital treatment data:whether surgical repair was performed,whether enterostomy was performed,the number of operation,combined use of NPWT,antibiotics,the type of antibiotics and the duration of application(day);All patients received LRINEC score and FGSI score,and the risk and severity of FG were assessed.(1)Descriptive analysis was conducted on the clinical data,disease data,wound data,auxiliary examination data and treatment data of all enrolled patients.According to the clinical conditions,the patients were divided into shock group and non-shock group.(2)Single factor analysis was made for related data including demographic data,disease data,wound data,auxiliary examination data,time factors and pre-hospital treatment data.(3)According to the positive results of univariate analysis,combined with the clinical experience,the confounding factors were excluded and included in the Logistic regression equation.After variable assignment,single factor positive variable was used as independent variable of multivariate Logistic regression analysis,and regression analysis was carried out with dependent variable.Statistical methods:SPSS 23.0 software was used to process the data.The counting data were expressed as percentage,chi-square(χ~2)or Fisher test was used,the measurement data were expressed by x±S,and the T test was used.P<0.05 means the difference was statistically significant.Results:Among the 50 patients with Fournier gangrene,the age ranged from 17 to 74 years old with the mean age of(51.7±14.57)years.The minimum age was 17 years old and the maximum was 74 years old.Among them,44 cases were male(88%,average age 52.02±14.16years old)and 6 cases were female(12%,average age 49.33±18.65 years old).Compared with rural residents,urban residents had a higher proportion of hospital admissions,accounting for66%(33 cases),while rural residents accounted for 34%(17 cases).On admission,42 patients had FG-related risk factor complications,of which the largest proportion was perianal disease and septic shock in 18 cases each,accounting for 48.64%of the total number of complications.The second was diabetes mellitus(43.24%).12 cases of renal insufficiency,accounting for 32.43%;6 cases of hypertension,accounting for 16.21%;There were 4 cases of urinary tract infection and 4 cases of cancer,accounting for 10.81%,and 3 cases of complicated paraplegia,accounting for 8.11%;The lesions were mainly affected in the perianal area(82%)(41 cases),followed by the scrotum(50%)(25 cases),perineum(32%)(16 cases),groin(24%)(12 cases),abdomen(16%)(8 cases),buttocks(14%)(7 cases),testis(6%)(3cases),and penis(2%)(1 case).Among the 50 patients enrolled,35 patients received wound secretion culture,4 of them were negative,and only one positive result was obtained from 22patients,6 with two positive results and 3 with three positive results.Is one of the most common E.coli accounting for 48.57%(17 cases),followed by pneumonia klebsiella bacillus accounted for 17.14%(6 cases),angina and streptococcus viridans streptococcus,each accounting for 8.57%(3 cases),sewer e.coli and pseudomonas aeruginosa accounting for 5.71%(2 cases),Corynebacterium genus,bacteroides fragilis,epidermis staphylococcus,streptococcus candida albicans,singular deformation bacteria,rotting,acinetobacter baumannii each accounted for 2.85%(1 case).In this study,the average hospitalization time of 50 patients was(21.82±17.75)days,and the average hospitalization cost was(9.2±648)thousounds yuan.The 50 cases of Fournier gangrene were divided into shock group(18 cases)and non-shock group(32 cases)according to their condition on admission.The univariate comparison between the groups was as follows:there were significant differences in the demographic data between the groups(P<0.001),was statistically significant;There were significant differences in the number of complications in the disease data(P<0.0001);The heart rate difference between the groups was significant(P=0.0215),which was statistically significant.Comparison of laboratory examination data on admission showed significant differences in WBC count,percentage of neutrophils,serum sodium ion concentration,serum bicarbonate and albumin(P=0.0107,P=0.0047,P=0.0089,P=0.0139,P=0.0489,respectively).In the data of nosocomial treatment,there was a significant difference among the array of antibiotics used(P=0.0.178),which was statistically significant.There were significant differences between the groups receiving fistula(P=0.007),and there were significant differences in the number of operations between the groups(P=0.0038).The comparison of hospitalization cost and length of hospitalization after admission showed that there were significant differences between the groups in hospitalization cost(P=0.0044)and length of hospitalization(P=0.0103).Significant differences were also observed in FGSI scores(P<0.0001).Conclusion:(1)Fournier gangrene of the occurrence and development may be associated with a number of factors,including gender,the number of complication,heart rate,leukocyte count,neutrophil percentage,sodium levels,blood levels of bicarbonate,albumin,antibiotics application species,whether colostomy surgery and operatio on the occurrence and development of Fournier gangrene exists a certain correlation.FGSI score has certain guiding significance in predicting the disease development of patients.(2)HCT may be an independent risk factor for the outcome of FG patients;Timely combined antibiotic therapy,repeated and thorough debridement surgery has positive significance for the prognosis of patients.(3)NPWT technology is more effective in the treatment of FG compared with surgical debridement technology alone.Compared with simple negative pressure and conventional negative pressure,negative pressure combined with irrigation can significantly shorten disease and accelerate wound healing time.NPWT technology can significantly shorten the duration of the patient’s disease,thus reducing treatment costs and lighting economic burden. |
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