Gaz olu�umuyla karakterize sinerjistik nekrotizan sel�lit �zellikleri ve tedavisi: Dokuz y�l� kapsayan geriye d�n�k �al��ma

Ling, Xiangwei; Ye, Yuanyuan; Guo, Hailei; Liu, Zhengjun; Xia, Weidong; Lin, Cai

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Gaz olu�umuyla karakterize sinerjistik nekrotizan sel�lit �zellikleri ve tedavisi: Dokuz y�l� kapsayan geriye d�n�k �al��ma [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2018; 24(2): 116-120 | DOI: 10.5505/tjtes.2017.93453

Gaz olu�umuyla karakterize sinerjistik nekrotizan sel�lit �zellikleri ve tedavisi: Dokuz y�l� kapsayan geriye d�n�k �al��ma

Xiangwei Ling¹, Yuanyuan Ye², Hailei Guo¹, Zhengjun Liu¹, Weidong Xia¹, Cai Lin¹
¹Wenzhou T�p �niversitesi Hastanesi, Yan�k B�l�m�, Wenzhou-�in Halk Cumhuriyeti
²Wenzhou T�p �niversitesi Hastanesi, Ameliyathaneler, Wenzhou-�in Halk Cumhuriyeti

AMA�: Bir�ok doktor gaz olu�umuyla karakterize sinerjistik nekrotizan sel�lit hakk�nda az bilgi sahiptir, �al��mam�zda bu durumu geriye d�n�k ara�t�rd�k.
GERE� VE Y�NTEM: Kas�m 2006 ile Eyl�l 2015 aras�nda gaz olu�umuyla karakterize sinerjistik nekrotizan sel�lit tan�s� konmu� toplam 30 hasta �al��maya al�nd�. On dokuz hastaya a��k drenaj uyguland�, 11 hastaya agresif debridman yap�ld�. Geriye d�n�k olarak demografiler, APACHE II skorlar�, patojenlerin k�lt�r sonu�lar�, ameliyat s�ras�nda kanama miktar�, beyaz k�reler ve derlenme geriye d�n�k olarak incelendi.
BULGULAR: �l�m oranlar� a��k drenaj ve agresif debridman gruplar�nda s�ras�yla %26 ve %73 idi (p=0.023). Tedavi �ncesinde iki grup aras�nda APACHE II skorlar� a��s�ndan herhangi bir istatistiksel farkl�l�k yoktu (16.6�4.5�e kar��n 18.1�7.5, p=0.511). Tedavi sonras�nda agresif tedavi grubunda APACHE II skoru anlaml� derecede daha y�ksek idi (14.2�5.8�e kar��n 20.1�9.1, p=0.038). Tedavi �ncesi ve sonras� aras�nda beyaz k�re say�s�nda istatistiksel farkl�l�k yoktu (13.49�5.05�109 h�cre/L�e kar��n 17.46�6.94�109 h�cre/L, p=0.082; 10.37�3.54�109 h�cre /L ve 15.47�7.51�109 h�cre /L, p=0.055). Ameliyat s�ras�nda kanama agresif debridman grubunda anlaml� derecede daha fazla idi (315�112 ml�ye kar��n 105�45 ml, p=0.000).
TARTI�MA: Sinerjistik nekrotizan sel�lit tedavisi i�in hasta kabulden sonra olabildi�ince en k�sa s�rede a��k drenaj yap�lacak en �nemli giri�imdir.

Anahtar Kelimeler: Gaz olu�turan enfeksiyonlar, gazl� kangren; sinerjistik nekrotizan sel�lit.

Features and treatment of gas-forming synergistic necrotizing cellulitis: a nine-year retrospective study

Xiangwei Ling¹, Yuanyuan Ye², Hailei Guo¹, Zhengjun Liu¹, Weidong Xia¹, Cai Lin¹
¹Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People�s Republic of China
²Operating Rooms, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People�s Republic of China

BACKGROUND: As many doctors know little about gas-forming synergistic necrotizing cellulitis, we retrospectively explored it in our study.
METHODS: Totally, 30 patients diagnosed with gas-forming synergistic necrotizing cellulitis between November 2006 and September 2015 were included. They were divided into two groups: open drainage group (19 patients) and aggressive debridement group (11 patients). Retrospectively analyzed data comprised demographic characteristics, APACHE II scores, pathogen culture results, bleeding amount during the operation, white blood cell count, length of hospital stay and recovery.
RESULTS: The mortality rate was 26% in the open drainage group and 73% in the aggressive debridement group (p=0.023). There was no statistical difference in the APACHE II score before treatment between the open drainageand aggressive debridement groups (16.6�4.5 vs 18.1�7.5, p=0.511). The APACHE II score was significantly higher after treatment in the aggressive debridement group (14.2�5.8 score vs 20.1�9.1, p=0.038). There were no statistical differences in the white blood count cell before and after treatment (13.49 � 109�5.05�109 cells/L vs 17.46�109�6.94�109 cells/L, p=0.082; 10.37�109�3.54�109 cells/L vs 15.47�109�7.51�109 cells/L, p=0.055; respectively). The bleeding amount during the operation was significantly more in the aggressive debridement group (315�112 ml vs 105�45 ml, p<0.001.
CONCLUSION: For treating gas-forming synergistic necrotizing cellulitis, performing open drainage as early as possible isthe most important procedure after admission.

Keywords: Gas-forming infections, gas gangrene; synergistic necrotizing cellulitis.

Sorumlu Yazar: Cai Lin, China
Makale Dili: �ngilizce

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