grekovВестник хирургии имени И.И. ГрековаGrekov's Bulletin of Surgery0042-4625Federal State Budgetary Educational Institution of Higher Education «Academician I.P. Pavlov First St. Petersburg State Medical University» of the Ministry of Healthcare of the Russion Federation, FSBEI HE I.P.Pavlov SPbSMU MOH Russia10.24884/0042-4625-2022-181-2-39-48grekov-1971Research ArticleВОПРОСЫ ОБЩЕЙ И ЧАСТНОЙ ХИРУРГИИPROBLEMS OF GENERAL AND SPECIAL SURGERYГангрена Фурнье: современное состояние проблемы и наш опыт леченияFournier’s gangrene: the current state of the problem and our treatment experiencehttps://orcid.org/0000-0002-3974-0781АлиевС. А.AlievS. A.

Алиев Садай Агалар оглы - доктор медицинских наук, профессор кафедры хирургических болезней № 1

Баку, ул. Братьев Мардановых, д. 100

Aliev Saday A. - Dr. of Sci. (Med), Professor of the Department of Surgical Diseases № 1

100, Bratev Mardanovykh str., Baku

sssalaeva@gmail.comhttps://orcid.org/0000-0002-2848-7370АлиевЭ. С.AlievE. S.

Алиев Эмиль Садай оглы - кандидат медицинских наук, старший лаборант кафедры хирургических болезней № 1

Баку, ул. Братьев Мардановых, д. 100

Aliev Emil S. - Cand. of Sci. (Med), Assistant of the Department of Surgical Diseases № 1

100, Bratev Mardanovykh str., Baku

Азербайджанский медицинский университетАзербайджанAzerbaijan Medical UniversityAzerbaijan20222803202218123948Copyright © Алиев С.А., Алиев Э.С., 20222022Алиев С.А., Алиев Э.С.Aliev S.A., Aliev E.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vestnik-grekova.ru/jour/article/view/1971

ЦЕЛЬ. Анализ результатов лечения больных с молниеносной гангреной мошонки (гангреной Фурнье, ГФ) на основании собственных исследований.МЕТОДЫ И МАТЕРИАЛЫ. В основу работы положен анализ результатов лечения 31 больного мужского пола с ГФ в возрасте от 32 до 82 лет. У 19 (61,3 %) больных наиболее вероятными нозологическими причинами гангрены Фурнье явились заболевания аноректальной зоны, у 10 – патология урогенитальной сферы. У 2 больных гангрена Фурнье развилась вследствие закрытой травмы (1) и огнестрельного ранения (1) промежности и мошонки. Ограниченная (медленно прогрессирующая) форма заболевания наблюдалась у 18 (58,1 %) больных, распространенная форма с молниеносным (9) и быстропрогрессирующим (4) течением – у 13 (41,9 %). Сахарным диабетом различной степени тяжести страдали 6 (19,3 %) больных. У всех больных клинические проявления заболевания и лабораторные показатели характеризовались явлениями генерализованной хирургической инфекции с признаками синдрома системного воспалительного ответа и эндотоксикоза. У 93,5 % больных каузативная микрофлора была представлена различными ассоциациями как факультативно-анаэробных и облигатно-аэробных грамотрицательных, так и облигатнофакультативных анаэробных грамположительных микроорганизмов. Получен также рост анаэробной грамотрицательной неклостридиальной флоры.РЕЗУЛЬТАТЫ. Из 31 больного умерли 6 (19,3 %) больных, у которых имелась распространенная форма ГФ с молниеносным и быстропрогрессирующим клиническим течением, манифестирующим синдромом системного воспалительного ответа и системного эндотоксикоза с исходом в органно-системную дисфункцию. Причинами смерти стали септический шок (у 1), прогрессирующий системный эндотоксикоз (сепсис) с исходом в полиорганную недостаточность (у 3) и тромбоэмболия легочной артерии (у 2).ЗАКЛЮЧЕНИЕ. Мультидисциплинарный подход к решению организационных и лечебно-тактических задач с участием врачей смежных специальностей, активная хирургическая тактика в формате «агрессивной хирургии», предусматривающей максимально широкое иссечение некротизированных и нежизнеспособных тканей, выполняемая в сочетании с программированной (этапной) санационной некрэктомией, патогенетически обоснованная коррекция нарушений системы гомеостаза, рациональная антибактериальная терапия, комплексная система местного лечения раны и пластическое замещение утраченных покровных тканей являются приоритетными путями оптимизации результатов лечения больных с гангреной Фурнье.

The OBJECTIVE of the study was to analyze the results of treatment of patients with lightning scrotal gangrene (Fournier’s gangrene).METHODS AND MATERIAL. The work is based on the analysis of the results of treatment of 31 patients with Fournier’s gangrene aged 32 to 82 years. In 19 (61.3 %) patients, the most probable nosological causes of Fournier’s gangrene were diseases of the anorectal zone, in 10 – pathology of the urogenital sphere. In 2 patients, Fournier’s gangrene developed as a result of a closed injury (1) and a gunshot wound (1) of the perineum and scrotum. A limited (slowly progressing) form of the disease was observed in 18 (58.1 %) patients, a common form with a lightning (9) and rapidly progressing (4) course – in 13 (41.9 %). 6 (19.3 %) patients suffered from diabetes mellitus of varying severity. In all patients, the clinical manifestations of the disease and laboratory parameters were characterized by the phenomena of generalized surgical infection with signs of systemic inflammatory response syndrome and endotoxicosis. In 93.5 % of patients, causative microflora was represented by various associations of both facultative-anaerobic and obligateaerobic gram-negative and obligate-facultative anaerobic gram-positive microorganisms. The growth of anaerobic gramnegative non-clostridial flora was also obtained.RESULTS. Out of 31 patients, 6 (19.3 %) patients died who had a common form of FG with a lightning and rapidly progressing clinical course in the format of systemic inflammatory response syndrome and systemic endotoxicosis with an outcome in organ-system dysfunction. The causes of death were: septic shock (in 1), progressive systemic endotoxicosis (sepsis) with the outcome of multiple organ failure (in 3) and pulmonary embolism (in 2).CONCLUSION. Multidisciplinary approach to solving organizational and therapeutic and tactical tasks with the participation of doctors of related specialties, active surgical tactics in the format of «aggressive surgery», providing for the widest possible excision of necrotic and non-viable tissues, performed in combination with programmed (stage-by-stage) sanitation necrectomy, pathogenetically justified correction of violations of the homeostasis system, rational antibacterial therapy, a comprehensive system of local wound treatment and plastic replacement of lost integumentary tissues are priority ways to optimize the results of treatment of patients with Fournier’s gangrene.

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The authors declare that there are no conflicts of interest present.