[Analysis of clinical data of necrotizing fasciitis secondary to intestinal fistulas and screening the mortality risk factors]

Abstract

Objective: To analyze the clinical data and to screen the mortality risk factors of necrotizing fasciitis (NF) secondary to intestinal fistulas (NFsIF). Methods: This study was a retrospective observational study. The data of all NFsIF cases who met the inclusion criteria and were admitted into Shandong Provincial Hospital Affiliated to Shandong First Medical University (hereinafter referred to as our unit) from January 2000 to October 2023, and in PubMed, Web of Science, Scopus, China National Knowledge Infrastructure, and Chinese Medical Journal Network databases from its establishment to October 2023 were retrieved and screened. Based on clinical outcomes, the cases were divided into survival group (47 males and 24 females) and death group (16 males and 7 females), and the mortality rate was calculated. Clinical data of patients in the two groups including age, underlying diseases (most related to NF), symptom duration before presentation, white blood cell count, causes of NF, signs of peritonitis, scope of NF involvement, and intestinal management and wound management measures were compared and analyzed to screen the risk factors of death in 94 patients with NFsIF. Results: A total of 94 valid cases were collected, including 90 patients reported in the literature and 4 patients admitted to our unit, with the mortality rate of patients being 24.5% (23/94). Univariate analysis showed that there were no statistically significant differences in age, underlying diseases, symptom duration before presentation, white blood cell count, causes of NF, signs of peritonitis, scope of NF involvement between patients in the two groups (P>0.05); there were statistically significant differences in intestinal treatment and wound treatment between the two groups (with χ² values of 17.97 and 8.33, respectively, P<0.05). Multivariate logistic regression analysis showed that both intestinal treatment measures and wound treatments measures were independent risk factors for death in 94 NFsIF patients, among which first-stage colostomy+late-stage reconstruction and negative presssure therapy had higher protective effects (with odds ratios of 0.05 and 0.27, respectively, 95% confidence intervals of 0.01-0.33 and 0.08-0.88, respectively, P<0.05). Conclusions: The mortality risk of patients with NFsIF is high. Based on comprehensive treatments, active intestinal and wound treatment may be the key to avoid death, with first-stage colostomy+late-stage reconstruction and negative pressure therapy having higher protective effects.

图 1

直肠瘘继发右下肢坏死性筋膜炎例1患者诊断过程。1A.入院时CT示盆腔及右侧皮下多发游离气体；1B.入院3 h急诊探查见右下肢后内侧切开后皮下及肌间隙广泛筋膜坏死，大量脓性及粪便样物质积聚；1C.入院5 d肠镜示直肠下段巨大瘘口；1D.入院35 d引流管逆行碘造影CT扫描+三维重建示腹膜后脓腔与盆底脓腔贯通 Diagnosis process of necrotizing fasciitis of the right lower limb secondary to rectal fistula in case 1

图 2

回肠瘘继发右大腿坏死性筋膜炎例2患者的诊断过程。2A.入院时右侧臀部肌肉间隙内可见游离气体（上侧图），右大腿上段后侧可见肌肉深部巨大腔隙伴内侧软组织坏死液化缺损（下侧图）；2B.入院3 d后，消化道碘水造影显示回肠-盆腔瘘（见红色椭圆标记） Diagnosis process of necrotizing fasciitis of the right thigh secondary to ileal fistula in case 2