RESUMO
BACKGROUND: Fournier's gangrene is a necrotising fasciitis that usually affects the external genitalia and perineal area and may extend to the abdomen, lower limbs and chest. It hasa high fatality rate and must be treated aggressively within a few hours of being diagnosed. It is believed that debilitating diseases such as diabetes mellitus or obesity are conducive to its appearance. A perianal abscess is the most common trigger. OBJECTIVE: To conduct a thorough descriptive analysis of risk factors and predisposing conditions for Fournier's gangrene based on our institution's experience over the past 12 years and reveal the mortality rate for those factors as well as the average number of reoperations performed. MATERIAL AND METHODS: This observational retrospective study examines 20 patients, according to clinical inclusion criteria, who were diagnosed with Fournier's gangrene, and treated in J.M. Morales Meseguer Hospital between 1997 and 2008. RESULTS: The vast majority of patients reviewed were males, with an average age of 61 years. All patients had a significant history of organic pathology, particularly diabetes mellitus. The average hospital stay was 25.7 days. 2 patients died, and the overall mortality rate was 10%. CONCLUSIONS: Fournier's gangrene is an entity that can be lethal and it is favoured by several debilitating factors. It is triggered by a urogenital or perirectal disease that has not been treated properly. Because of its poor prognosis, early diagnosis and an appropriate early and aggressive multidisciplinary intervention are essential for proper recovery.
Assuntos
Gangrena de Fournier , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gangrena de Fournier/diagnóstico , Gangrena de Fournier/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJETIVO: El cáncer de pene es una entidad poco frecuente. Para realizar un buen control oncológico, se recomienda la realización de linfadenectomía inguinal en casos de factores de riesgo de mal pronóstico, grado histológico alto o ganglios palpables o positivos. La linfadenectomía inguinal abierta presenta una alta tasa de morbilidad, por lo que en esta revisión se pretende resumir la literatura publicada en cuanto a los resultados oncológicos y postquirúrgicos en la linfadenectomía inguinal videoendoscópica (VEIL). MATERIAL Y MÉTODOS: Se realiza revisión sistemática de la literatura obtenida en "Pubmed", "EMBASE" y Cochrane library para artículos en inglés y español. RESULTADOS: Se han analizado un total de 12 artículos, que globalmente incluyen a 161 pacientes con 226 VEIL y una edad media de 55,66 años y 90 pacientes a los que se les ha realizado 106 linfadenectomías abiertas. En el caso del VEIL se han presentado 6% de complicaciones cutáneas y del 55,6% en el caso de la vía abierta. En cuanto a las complicaciones linfáticas, no hay diferencias significativas. La media de ganglios extraídos en el caso de VEIL de 9,12 ganglios y de 7,09 ganglios en abordaje abierto. CONCLUSIONES: La linfadenectomía inguinal videoendoscópica aporta una menor morbilidad, con una menor tasa de complicaciones cutáneas, y de menor gravedad. Asimismo, aporta menor estancia hospitalaria, sin afectación de los resultados oncológicos iniciales. Aunque se necesitan series con mayor tiempo de seguimiento para valoración de resultados oncológicos a largo plazo
OBJECTIVES: Penile cancer is not very frequent. To control the disease oncologically, we must perform inguinal lymphadenectomy in cases of high-risk histology, poor prognosis and palpable lymph nodes. The open inguinal lymphadenectomy has a high rate of morbidity. Consequently, this systematic review intends to summarize the published literature regarding the oncologic and post-surgery outcomes METHODS: A literature search has conducted through Pubmed, EMBASE and Cochrane library for English and Spanish articles. RESULTS: Our literature search identified 12 articles. In total, 161 patients have been subjected to 226 VEIL. Their average age was 55.66 years. In the case of open inguinal lymphadenectomy, 90 patients have been subjected to 106 operations. The rate of cutaneous complications was 6% for VEIL and 55.6% for open lymphadenectomy. The rate of lymphatic complications was very similar in both types of lymphadenectomy. The average number of lymph nodes obtained was 9.12 for VEIL and 7.02 lymph nodes for the open approach. CONCLUSION: Video-endoscopic inguinal lymphadenectomy contributes to less morbidity with a lower-rate of cutaneous complications and less severity. Furthermore, VEIL gives lower hospital stay without changing in initial oncologic outcomes. Although we need longer series to stablish the oncologic long-term results
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Excisão de Linfonodo/métodos , Neoplasias Penianas/cirurgia , Cirurgia Vídeoassistida , Endoscopia , Canal InguinalRESUMO
Introducción: La gangrena de Fournier es una fascitis necrosante que afecta habitualmente a la zona genital externa y perineal, con eventual extensión al abdomen, los miembros inferiores e incluso el tórax, con alta letalidad, que debe tratarse de manera agresiva en las primeras horas tras el diagnóstico. Se considera que enfermedades debilitantes como la diabetes mellitus u la obesidad favorecen su aparición. El factor desencadenante más frecuente es el absceso perianal. Objetivo: Realizar un profundo análisis descriptivo sobre los factores de riesgo y las afecciones predisponentes de la gangrena de Fournier durante toda la historia de nuestro centro, durante los últimos 12 años, así como revelar la tasa de mortalidad de éstos y el número medio de reintervenciones realizadas. Material y métodos: El estudio realizado analiza, de manera observacional y retrospectiva, a 20 pacientes diagnosticados de gangrena de Fournier, según criterios de inclusión clínicos, en el Hospital General Universitario J.M. Morales Meseguer entre 1997 y 2008. Resultados: La gran mayoría de los pacientes revisados eran varones, con una edad media de 61 años. Todos tenían una importante afección orgánica de base; destacaba la diabetes mellitus. La estancia media hospitalaria fue de 25,7 días. Fallecieron 2 pacientes y la mortalidad global fue del 10%. Conclusiones: La gangrena de Fournier es una entidad que puede ser letal, que está favorecida por distintos factores debilitantes, cuya causa desencadenante es una enfermedad perirrectal o urogenital que no ha sido tratada correctamente. Debido a su pronóstico grave, un diagnóstico temprano y una intervención multidisciplinaria adecuada, temprana y agresiva son esenciales para una buena evolución (AU)
Background: Fourniers gangrene is a necrotising fasciitis that usually affects the external genitalia and perineal area and may extend to the abdomen, lower limbs and chest. It has a high fatality rate and must be treated aggressively within a few hours of being diagnosed. It is believed that debilitating diseases such as diabetes mellitus or obesity are conducive to its appearance. A perianal abscess is the most common trigger. Objective: To conduct a thorough descriptive analysis of risk factors and predisposing conditions for Fourniers gangrene based on our institutions experience over the past 12 years and reveal the mortality rate for those factors as well as the average number of reoperations performed. Material and methods: This observational retrospective study examines 20 patients, according to clinical inclusion criteria, who were diagnosed with Fourniers gangrene, and treated in J.M. Morales Meseguer Hospital between 1997 and 2008. Results: The vast majority of patients reviewed were males, with an average age of 61 years. All patients had a significant history of organic pathology, particularly diabetes mellitus. The average hospital stay was 25.7 days. 2 patients died, and the overall mortality rate was 10%.Conclusions: Fourniers gangrene is an entity that can be lethal and it is favoured by several debilitating factors. It is triggered by a urogenital or perirectal disease that has not been treated properly. Because of its poor prognosis, early diagnosis and an appropriate early and aggressive multidisciplinary intervention are essential for proper recovery (AU)