التهاب اللفافة النخري ( موات فورنيير ) تشخيص وعلاج
Abstract
شملت الدراسة 13 مريضاً، تراوحت أعمارهم مابين 20-80 سنة (9 مرضى ذكور و4 مرضى إناث) والذين قبلوا وعولجوا في قسم الجراحة بمشفى الأسد الجامعي باللاذقية مابين 1997-2007 .
تضمنت المعالجة إعطاء الصادات الحيوية واسعة الطيف والتنضير الجراحي الواسع ودعم الحالة العامة.
9 مرضى كان لديهم داء سكري، والجرثومة الأكثر توارداً كانت جرثومة الـ E.COLI ، تلتها المطثيات.
فترة بقاء المريض في المشفى حوالى شهر، حدثت حالتا وفاة من مرضى الدراسة في الأسبوع الأول من الإصابة. وأجريت جراحات ترميمية لاحقة للمرضى الذين حدث لديهم ضياع مادي كبير في الجلد .
التهاب اللفافة النخري خمج مهدد للحياة نادر متعدد العوامل الممرضة (هوائية ولاهوائية) يتظاهر بنخر سريع مترقٍ للنسيج تحت الجلد واللفافات مؤدياً لموات الجلد، وهو إسعاف جراحي حقيقي، يحتاج المرضى غالباً لفريق متعدد الاختصاصات متضمناً ( جرّاحاً عاما ًوجرّاحاً بولياً وطبيب عناية مشددة) حيث إن أهم خطوة في العلاج هو التنضير الجراحي الواسع.
The study included 13 patients ranging in age from 20-80 years ( 9 males and 4 females), who had been admitted to and treated in the Department of Surgery at Assad University Hospital in Lattakia between 1997 and 2007. Treatment included antibiotics, aggressive surgical intervention, and supportive therapy. 9 patients were diabetic. E.coli were the most common microbes isolated followed by clostridium. Necrotizing Fasciitis is an uncommon but life threatening multi-microbal soft tissue infection characterized by a progressive, rapid, necrotizing process of the subcutaneous tissue and fascial planes with resulting gangrene of the skin. Fournier gangrene is a true surgical emergency. Patients often require a multidisciplinary team. The most important step in treatment is aggressive surgical intervention.
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