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Fournier's Gangrene의 적극적 치료의 필요성

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Author(s)
김병훈장혁수박철희김천일김광세
Keimyung Author(s)
Kim, Byung HoonChang, Hyuk SooPark, Choal HeeKim, Chun IlKim, Kwang Sae
Department
Dept. of Urology (비뇨의학)
Journal Title
대한비뇨기과학회지
Issued Date
2004
Volume
45
Issue
8
Abstract
Purpose: The mortality of patients with Fournier's gangrene remains at 15-50%, despite the improvement in critical care, the liberal use of broad spectrum antibiotics and the emphasis on aggressive surgical debridement. Therefore, the factors impacting on the survival and necessity for aggressive management were evaluated by comparing the medical records of survivors and non-survivors of Fournier's gangrene.
Material and Methods: The medical records of 20 patients with Fournier's gangrene treated over a 12-year period were reviewed. The patients' ages ranged between 20 and 90 years (mean 55). The predisposing factors and extended surface area of necrosis were analysed by outcome. The number of surgical debridements and their timing, with respect to initial presentation and diversions, were analysed according to the extended surface area (3%). The outcome of the surgical treatments of patients with fever or sepsis at the time of the initial hospital visit was analyzed.
Results: The predisposing factors included diabetes mellitus (10 cases, 50%), general weakness (7 cases, 35%), alcohol abuse (5 cases, 25%), malignant disease (3 cases, 15%) and hemiplegia (2 cases, 10%). Of the 20 patients, 3 (15%) died and 17 (85%) survived. One patient died due to septic shock before undergoing surgical debridement. The mean surface area involved with the disease among the survivors and non survivors were 3.6 and 3.7%, respectively. The patients with an extended surface below 3% (n=10) had 1.5 times the mean number of debridements. Of these, diversion was performed in one patient, three patients had complications and one patient died. The patients with an extended surface over 3% (n=9) had 2.3 times the mean number of debridements. Of these, five patient was performed diversion, tree patients had complication and one patient died. Of the 11 patient with fever or sepsis, 2 that did not undergone first debridement within 24hr of presentation died. However, all the patients who underwent first debridement within 24hr of presentation survived.
Conclusions: The patient's physiological status influenced by the predisposing factors played the important role in the outcome. With aggressive treatment, including early and repeat surgical intervention and diversion, the disease has a reduced mortality. (Korean J Urol 2004;45:793-799)
Alternative Title
Necessity of Aggressive Management in Fournier's Gangrene
Keimyung Author(s)(Kor)
김병훈
장혁수
박철희
김천일
김광세
Publisher
School of Medicine
Citation
김병훈 et al. (2004). Fournier’s Gangrene의 적극적 치료의 필요성. 대한비뇨기과학회지, 45(8), 793–799.
Type
Article
ISSN
2005-6737
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/38702
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Urology (비뇨의학)
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