Fournier gangreni: 25 hastanýn geriye dönük analizi

AMAÇ: Fournier gangreni akut geliþen, hýzlý ve sinsi ilerleyen, taný ve tedavide geç kalýndýðýnda yüksek oranda morbidite ve mortalite ile sonuçlanan acil cerrahi bir hastalýktýr. Bu çalýþma ile kliniðimizde Fournier gangreni tanýsý ile takip ve tedavi edilen hastalarýn sonuçlarýný irdelemeyi amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþma, 2010–2015 yýllarý arasýnda Fournier gangreni tanýsýyla ameliyat edilen hastalarýn geriye dönük taranmasý ile yapýldý. Hastalarýn tanýsý fizik muayene ile konuldu. Genital, perineal ve perianal bölgede hassasiyet, endurasyon, siyanoz, gangren ve cilt altý krepitasyon saptanan olgular Fournier gangreni olarak kabul edildi. Resussitasyonu takiben agresif cerrahi debritman ve seçilmiþ olgularda debritmana ilave olarak ‘Vacuum Assisted Closure’ (VAC) uygulandý. Gerekli durumlarda mükerrer debritmanlar yapýldý. Hastalarýn takip ve tedavi sonuçlarý analiz edildi.
BULGULAR: Çalýþmaya 25 hasta dahil edildi. Bunlardan 14’ü (%56) kadýn, 11’i (%44) erkek olup yaþ ortalamasý 54.3 (daðýlým, 27–82) idi. Kadýnlarýn yaþ ortalamasý istatistiksel olarak daha yüksekti (p=0.001). Hastanede ortalama yatýþ süresi 21.4 gün, ortalama debritman sayýsý 2.4 kez idi. Hastalarýn 13’ünde (%52) perianal bölgede apse ve 20’sinde (%80) diabetes mellitus tespit edildi. Hastalarýn tümünde geniþ debritman, 16’sýnda (%64) ise debritmana ilave olarak VAC uygulamasý yapýldý. VAC uygulanan hastalarda hastanede ortalama yatýþ süresi ve ortalama debridman sayýsý istatistiksel olarak daha yüksek bulundu (sýrasýyla, p=0.004, p=0.048). Bir hastaya ostomi açýldý ve bir hasta mortal seyretti.
TARTIÞMA: Fournier gangreninde erken taný, etkili resüsitasyon, agresif debritman ve uygun olgularda debritmana ilave olarak VAC uygulanmasý ostomi ihtiyacýný, morbidite ve mortaliteyi azaltabilir.

Fournier’s gangrene: A retrospective analysis of 25 patients

BACKGROUND: Fournier’s gangrene is a surgical emergency that progresses rapidly and insidiously and results in high morbidity and mortality rates unless it is immediately diagnosed and managed. Here we analyze the outcomes of patients who were followed up and treated for Fournier’s gangrene.
METHODS: We conducted a retrospective analysis of the medical data of 25 patients operated on for Fournier’s gangrene between January 2010 and June 2015. The diagnosis of Fournier’s gangrene was made by performing a physical examination. Patients who had genital, perineal, and perianal tenderness; induration; cyanosis; gangrene; and subcutaneous crepitation were considered as having Fournier’s gangrene. Following resuscitation, aggressive surgical debridement was performed and vacuum-assisted closure (VAC) was conducted in addition to debridement in select patient. Repeat debridements were performed as requirement.
RESULTS: This study included 25 patients. Fourteen patients (56%) were females and 11 (44%) were males. The mean age of the patients was 54.3 years (range: 27–82 years). The mean duration of hospital stay was 21.4 days; the mean number of debridements performed was 2.4. Thirteen patients (52%) had perianal abscesses, and 20 (80%) had diabetes mellitus. All patients underwent extensive debridement; 16 patients (64%) underwent VAC in addition to debridement. Patients undergoing VAC had significantly longer durations of hospital stay and a higher mean number of debridements performed (p=0.004 and p=0.048, respectively). An ostomy was made in one patient, and one patient died.
CONCLUSION: In Fournier’s gangrene, early diagnosis, effective resuscitation, aggressive debridement, and VAC application in suitable cases may reduce the morbidity and mortality rates and the need for an ostomy.