Journal of Experimental and Clinical Surgery

Вестник экспериментальной и клинической хирургии

2070-478X2409-143X

Voronezh State Medical University named after N.N. Burdenko

984

10.18499/2070-478X-2017-10-2-154-164

Review of literature

Обзор литературы

Unknown

Fournier’s Gangrene: the Criteria for Diagnosis, Prognostic Factors, Complications and Mortality

Гангрена Фурнье: критерии диагностики, факторы прогноза, осложнения и летальность (обзор литературы)

Prokhorov

Andrew Vladimirovich

Прохоров

Андрей Владимирович

Russian Federation

PhD, head of the department of ultrasounddiagnostics

заведующий отделением ультразвуковой диагностики

botex@rambler.ru

D.D. Pletnev Moscow clinical hospital № 57ГБУЗ "Городская клиническая больница им. Д.Д. Плетнева Департамента здравоохранения г. Москвы", лечебно-диагностическое подразделение № 1

23092017

102

1541641203201701052017

2017

Voronezh N.N. Burdenko State Medical University

ФГБОУ ВО ВГМУ им. Н.Н. Бурденко Минздрава России

https://vestnik-surgery.com/journal/about/editorialPolicies

https://vestnik-surgery.com/journal/article/view/984

The early diagnosis, prognosis, complications and mortality Fournier’s gangrene (FG) are discussed. The terms pre-hospital period with FG is amount of 8.0 ± 5.2 days. Cases of misdiagnosis are observed in 70% in the early stages of FG due to nonspecific clinical and laboratory picture, lack of awareness and alertness of doctors. Early diagnosis of FG is based on clinical and laboratory data of the picture. In order to timely diagnosis of FG is used scale laboratory indicators of necrotizing fasciitis (LRINEC), allowing suspect FG in doubtful cases. In diagnostically unclear cases FG used radiation methods. At the slightest suspicion on the FG made explorative operation, including express biopsy of soft tissues. The differential diagnosis is carried out in the early stages of FG with acute diseases anogenital region and is rarely used. As a prognostic criteria discussed the patient's age, the presence and nature of comorbid diseases, severity of the condition, the hospital admission dates, duration of preoperative period, necrosis area, metabolic parameters, the amount of remedial necrectomy, antibiotic regimen, hyperbaric oxygen therapy. For the systematic evaluation of the severity of the patient's condition and prognosis use different scoring systems. Many of the proposed prognostic criteria are controversial. The favorable prognosis in FG is entirely dependent on early diagnosis and timing of emergency surgery. Sepsis and its complications are the main causes of deaths. Mortality in the FG has been a steady downward trend, and is 22.3 ± 8.8%. Prevention of the FG is a timely treatment of infectious and inflammatory diseases of the urinary organs and their complications.

Обсуждаются вопросы ранней диагностики, прогноза, осложнений и летальности при гангрене Фурнье (ГФ). Сроки догоспитального периода при ГФ составляют 8,0 ± 5,2 суток. Случаи ошибочной диагностики наблюдаются в 70% в ранней стадии ГФ вследствие неспецифичности клинической и лабораторной картины, недостаточной информированности и настороженности врачей. Ранняя диагностика ГФ основывается на данных клинико-лабораторной картины. В целях своевременной диагностики ГФ применяется шкала лабораторных предикторов некротизирующего фасциита, позволяющая заподозрить ГФ в сомнительных случаях. В диагностически неясных случаях ГФ используются лучевые методы исследования. При малейшем подозрении на ГФ осуществляется эксплоративная операция, включающая экспресс биопсию мягких тканей. Дифференциальная диагностика проводится в ранней стадии ГФ с острыми заболеваниями аногенитальной области и применяется редко. В качестве прогностических критериев обсуждаются возраст пациента, наличие и характер коморбидных заболеваний, тяжесть состояния, сроки поступления в стационар, длительность предоперационного периода, площадь некроза, метаболические параметры, количество санационных некрэктомий, режим антибактериальной терапии, гипербарическая оксигенотерапия. Для систематизированной оценки тяжести состояния пациента и прогноза заболевания используются различные скоринговые системы. Многие из предложенных прогностических критериев являются спорными. Благоприятный прогноз при ГФ всецело зависит от ранней диагностики и сроков неотложного хирургического вмешательства. Сепсис и его осложнения являются основными причинами летальных исходов. Летальность при ГФ имеет устойчивую тенденцию к снижению и составляет 22,3 ± 8,8%. Профилактикой ГФ является своевременное лечение инфекционно-воспалительных заболеваний мочеполовых органов и их осложнений.

Fournier’s gangrene, diagnosis, prognosis, complications, mortality

гангрена Фурнье, диагностика, прогноз, осложнения, летальность.

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