İBRAHİM TAYFUN ŞAHİNER, MURAT KENDİRCİ, Mete DOLAPÇI

Son Bir Yıl İçindeki Nekrotizan Fasiitis Tanısı Alan Hastaların Değerlendirilmesi

Amaç: Kliniğimize başvuran nekrotizan fasiitis hastalarının tanı, takip ve tedavisi ile ilgili deneyimleri paylaşmak. Yöntemler: 01.01.2016 ve 01.01.2017 tarihleri arasında kliniğimize başvuran nekrotizan fasiitis tanısı alan hastaların kayıtları incelendi. Hastaların yaş, cinsiyet, ek hastalık, toplam ameliyat sayısı, hastanede yatış gün sayısı ve tedaviye yanıtları incelendi. Bulgular: Nekrotizan fasiitis tanısı alan toplam 13 hasta kliniğimizde takip ve tedavi oldu. Hastaların %62'si erkek (n:8), %38'i kadın (n:5) cinsiyet idi. Hastaların ortalama yaşı 61 yaş (38 -80 yaş) olarak bulundu. Hastaların %69'unda (n:9) diyabetes mellitus tanısı var iken, 2 kadın hastanın over karsinomu nedeni ile bir yıl önce ameliyat geçirdikleri ve sonrasında kemo-radyoterapi aldıkları belirlendi. Diğer 2 hastanın anamnezlerinde geçirilmiş perianal apse ve fistül hikâyesi olduğu görüldü. Hastaların tümünde nekrotizan fassiitin başlangıç bölgesi perianal bölge idi. Hastaların tanı aldıktan sonra debritman için ortalama 3 kez ameliyata alındığı (min:2, max:6), debritmanı sonrası hastaların %69'una (n:9) negatif basınçlı kapama yöntemi uygulandığı, %31 hastaya ise (n:4) flep ile kapama uygulandığı görüldü. Tüm hastalardan debritman esnasında doku kültürü alındı ve nekrotizan fasiitis kültür sonucu ile doğrulandı. Hastaların %77'sinde (n:10) antibiyoterapi olarak seftriakson+ metranidazol kombinasyonu yeterli gelmiş iken geri kalan hastalarda imipenem grubu antibiyotik desteği gerekli olmuştur. Ortalama hastanede yatış gün sayısının24 gün olduğu (min:4, max:71) görüldü. Hastaların %92'si (n:12) başarılı bir şekilde şifa ile taburcu edilirken overCa zemininde gelişen nekrotizan fassitisli bir olgu postoperatif 34. gününde sepsis nedeniyle kaybedildi. Sonuç: Nekrotizan fasiitis erken tanı konularak tedavi edilmediğinde sıklıkla mortalite ile seyredebilen bir hastalıktır. Hastaların birçoğu immünsüpresif hasta olup tanı için gecikmeler yaşanabilir. Erken tanı konulan, tedavi için hızlı ve agresif debritman uygulanan hastalarda yüz güldürücü sonuçlar elde edilebilmektedir.

Evaluation of Patients with a Diagnosis of Necrotizing Fasciitis Within The Last Year

Objective: To share experiences about diagnosis, follow-up and treatment of necrotizing fasciitis patients who applied to our clinic. Methods: The records of patients who had a diagnosis of necrotizing fasciitis that referred to our clinic between 01.01.2016 and 01.01.2017 were retrospectively examined. Patients' age, sex, additional disease, total number of operations, duration of hospitality and treatment responses was examined. Results: A total of 13 patients with necrotizing fasciitis were followed up and treated at our clinic. We found 62% of the patients were male (n:8) and 38% were female (n:5). The mean age of the patients was 61 years (38-80 years). While 69% (n:9) of patients had diabetes mellitus, two female patients had under gone chemo-radio therapy last year due to over-carcinoma. The history of the perianal abscess and fistula was seen in the anamnesis of the other two patients. In all patients, necrotizing fasciitis was in the perianal region. After the diagnosis of the patients, an average of three times debridement were performed (min: 2, max: 6). Negative pressure wound closure was applied to 69% (n: 9) of the patients after debridement and 31% of the patients (n: 4) were treated with surgical flap methods. Tissue culture was obtained from all patients during debridement and the necrotizing fasciitis was confirmed with culture result. In 77% of patients (n: 10), ceftriaxone + metranidazole combination was sufficient as antibiotherapy whereas imipenem group antibiotic support was needed in there maining patients. The average hospital stay was 24 days (min: 4max: 71). Ninety percent of the patients (n: 12) were discharged successfully with healing and a case with necrotizing fasciitis developed due to over carcinoma was lost because of developing severe sepsis at postoperative 34th day. Conclusion: Necrotizing fasciitis is a disease that is frequently associated with mortality when it is not treated with early diagnosis. Many of the patients are immuno suppressed and for this reason diagnosis can be delayed. Patients with early diagnosis, rapid and aggressive debridement for treatment can obtain satisfactory results.

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