Fournier gangreninde floresans görüntüleme tekniği ile intra-operatif indosiyanin yeşili kullanarak doku perfüzyon haritalandırmasının konvansiyonel cerrahi yöntem ile kıyaslanması olgu eşleme çalışması
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Date
2022
Authors
Aljorani, Israa
Journal Title
Journal ISSN
Volume Title
Publisher
Bursa Uludağ Üniversitesi
Abstract
Fournier gangreni (FG), perinenin nekrotizan fasiitidir. Tipik olarak diyabetik hastalarda, üriner infeksiyon, perineal infeksiyon varlığında veya bağışıklığı baskılanmış hastalarda görülür. FG’nin tedavisi, nekrotik dokuların debridmanı, geniş spektrumlu antibiyotik tedavisi ve hemodinamik destek ile erken agresif cerrahi debridmandan oluşur. Bursa Uludağ Üniversitesi Genel Cerrahi Anabilim Dalı’nda 1 Ocak 2020 ile 1 Ocak 2022 tarihleri arasında FG tanısı olan, Uludag Fournier’s Gangrene Severity Index (UFGSI) skoru 9’ un üzerinde, OAB<60 mmHg ve multiorgan yetmezliğine veya sepsise bağlı eksitus olan hastalar dışlandıktan sonra 10 FG olgusu (s grup) çalışmaya dahil edilmiştir. Bu hasta grubunda cerrahi debridman sırasında İndosiyanin yeşili (ICG) ile floresan görüntüleme kullanarak intraoperatif doku perfüzyon değerlendirilmesi yapılmıştır. Elde edilen sonuçlara göre yapılan debridmanın yeterli olup olmadığına karar verilmiştir. Bu hasta grubu ile 1 Ocak 2020’ den önce FG nedeniyle konvansiyonel cerrahi debridman yapılarak takip edilmiş olan 20 olgu (c grup) karşılaştırıldı. ICG kullanılarak floresan görüntüleme yöntemiyle doku perfüzyon değerlendirilmesi yapılmasının, hastaların klinik özellikleri ve UFGSI skoru dikkate alınarak debridman seans sayısı ve yatış süresi üzerine etkisi araştırıldı. Medyan debridman seans sayısı s grubunda 5 (Q1-Q3: 2,5 – 6,25), c grubunda 6 (Q1-Q3: 4,0 – 11,5) olarak bulunmuştur (p 0,169). Hastanede medyan yatış süresi s grubunda 23,00 (Q1-Q3: 11,25-27,25) gün, c grubunda 27,00 (Q1-Q3: 19,25-51,00) gün olarak saptanmıştır (p 0,183). ii ICG kullanılarak floresan görüntüleme yöntemiyle doku perfüzyon değerlendirilmesi yapılan grupta daha az debridman sayısı ve ona bağlı hastanede daha kısa yatış süresi tespit edilmiştir ancak istatistiksel olarak anlamlı fark gösterilememiştir.
Fournier's gangrene (FG) is a necrotizing fasciitis of the perineum. It is typically seen in diabetic patients, who urinary infection, infection of the perineum or are immunocompromised. Treatment of FG consists of early aggressive surgical debridement of necrotic tissue, broad spectrum antibiotic therapy, and hemodynamic support. At Bursa Uludag University Department of General Surgery between January 1, 2020 and January 1, 2022, 10 patients presented with FG’s features (s group) were included in the study. Uludag Fournier's Gangrene Severity Index score> 9, MAP <60 mmHg, and patients who died due to multiorgan failure or sepsis had been excluded. In their surgical debridments Indocyanine Green (ICG) fluorescence imaging technique was used for intraoperative evaluation of tissue perfusion and according to its results the debridement was terminated. These patients were compared with 20 FG patients (c group) that had been treated before January 1, 2020 with conventional surgical debridement. The effects of this technique upon the number of debridement sessions and duration of hospitalization were investigated. While the median number of debridement sessions was 5 (Q1-Q3: 2.5 – 6.25) in s group, it was 6 (Q1-Q3: 4.0 – 11.5) in c group (p 0.169). The median hospital stay was 23,00 (Q1-Q3: 11,25-27,25) days in group s and 27,00 (Q1-Q3: 19,25-51,00) days in group c (p 0.183). In spite of that the use of ICG fluorescence imaging technique in FG debridment showed lesser surgical debridment sessions and in order to that shorter period of patient’s hospitalization was needed, no statistically significant difference was found.
Fournier's gangrene (FG) is a necrotizing fasciitis of the perineum. It is typically seen in diabetic patients, who urinary infection, infection of the perineum or are immunocompromised. Treatment of FG consists of early aggressive surgical debridement of necrotic tissue, broad spectrum antibiotic therapy, and hemodynamic support. At Bursa Uludag University Department of General Surgery between January 1, 2020 and January 1, 2022, 10 patients presented with FG’s features (s group) were included in the study. Uludag Fournier's Gangrene Severity Index score> 9, MAP <60 mmHg, and patients who died due to multiorgan failure or sepsis had been excluded. In their surgical debridments Indocyanine Green (ICG) fluorescence imaging technique was used for intraoperative evaluation of tissue perfusion and according to its results the debridement was terminated. These patients were compared with 20 FG patients (c group) that had been treated before January 1, 2020 with conventional surgical debridement. The effects of this technique upon the number of debridement sessions and duration of hospitalization were investigated. While the median number of debridement sessions was 5 (Q1-Q3: 2.5 – 6.25) in s group, it was 6 (Q1-Q3: 4.0 – 11.5) in c group (p 0.169). The median hospital stay was 23,00 (Q1-Q3: 11,25-27,25) days in group s and 27,00 (Q1-Q3: 19,25-51,00) days in group c (p 0.183). In spite of that the use of ICG fluorescence imaging technique in FG debridment showed lesser surgical debridment sessions and in order to that shorter period of patient’s hospitalization was needed, no statistically significant difference was found.
Description
Keywords
Fournier gangreni, İCG, Cerrahi debridman, Fournier gangrene, ICG, Surgical debridement
Citation
Aljorani, I. (2022). Fournier gangreninde floresans görüntüleme tekniği ile intra-operatif indosiyanin yeşili kullanarak doku perfüzyon haritalandırmasının konvansiyonel cerrahi yöntem ile kıyaslanması olgu eşleme çalışması. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.