目的:研究肠改道和重建手术在治疗Fournier坏疽(FG)中的作用,以促进泌尿科医师之间的多学科合作,结直肠和整形外科团队。
方法:使用Medline数据库对文献进行了综述,Embase,2023年6月PubMed。该综述包括评估FG在重建手术或转移结肠造口术后的结果的研究。
结果:现有证据表明肠改道和结肠造口术可以减少进一步清创的需要,缩短伤口愈合的时间,并促进FG患者的皮肤移植或皮瓣摄取。此外,造口的心理影响被证明不是患者的主要问题。然而,造口具有围手术期并发症的风险,因此可能延长住院时间。在审查FG重建的证据时,大的和深的缺陷似乎受益于皮肤移植或皮瓣。值得注意的是,由于担心睾丸的温度调节和对患者的心理影响,将睾丸埋在大腿袋中已不再受欢迎。
结论:在FG管理中使用肠改道和重建手术是病例依赖性的。因此,在管理FG时,与结直肠和整形外科团队进行密切讨论是很重要的.
OBJECTIVE: To examine the role of bowel diversion and reconstructive surgeries in managing Fournier\'s gangrene (FG) to facilitate multidisciplinary collaboration between urologists, colorectal and plastic surgery teams.
METHODS: A
review of the literature was conducted using the databases Medline, Embase, PubMed in June 2023. The
review included studies that evaluated the outcomes of FG following reconstructive surgeries or diverting colostomies.
RESULTS: The existing evidence suggests that bowel diversion and colostomy formation could reduce the need for further debridement, shorten the time to wound healing, and facilitate skin graft or flap uptake in patients with FG. Additionally, the psychological impact of a stoma was shown not to be a major concern for patients. However, stoma carries a risk of perioperative complications and therefore may prolong the length of hospital stay. In reviewing the evidence for reconstruction in FG, large and deep defects seem to benefit from skin grafts or flaps. Noticeably, burial of testicles in thigh pockets has grown out of favour due to concerns regarding the thermoregulation of the testicles and the psychological impact on patients.
CONCLUSIONS: The use of bowel diversion and reconstructive surgeries in managing FG is case dependent. Therefore, it is important to have close discussions with colorectal and plastic surgery teams when managing FG.