Fournier 괴저 환자에 있어 예후인자 분석
Analysis of Prognostic Factors in Patients with Fournier's Gangrene
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목 적 : 여러 연구에서 생존에 영향을 미치는 예후인자에 대해 보고하고 있지만, 아직까지 명확히 정립되지 않은 상태이다. 이에 저자들은 지난 15년간 경험한 27예의 Fournier 괴저 환자를 분석하여 임상경과와 치료결과를 예측할 수 있는 예후인자에 대해 분석하였다.재료 및 방법 : 1990년 1월부터 2005년 12월까지 본원에서 Fournier 괴저으로 치료받았던 27명을 대상으로 입원기록을 통해 후향적으로 분석하였다. 환자는 사망군과 생존군으로 나누어 진단 당시의 나이, 증상 발현부터 내원까지 걸린 시간, 기저질환, 병변의 범위, 검사실 소견, 임상경과 등을 비교하였다.결 과 : 생존군과 사망군은 각각 23명과 4명이었으며, 전체 환자들의 평균 연령은 55.36±13.74세(25-77)였다. 가장 흔한 기저질환은 당뇨병이었다. 생존군과 사망군을 비교시 증상발현 후 내원 시까지 걸린 시간, 괴사면적, 혈청 알부민, 혈청 크레아티닌, 백혈구 수 등이 통계학적 차이를 보였으며, 환자의 나이, 유발인자, 당뇨병이나 악성 종양과 같은 기저질환, 재원 기간, 요로 혹은 대장전환술, 병원균 등은 통계학적 의의를 보이지 않았다.
Abstract
Background:To evaluate prognostic factors such as age, associated disease, laboratory and clinical data, which can affect prognosis of patients with Fournier's gangrene. Materials and Methods:27 patients were included in this study. All underwent treatment during past 15-year in our department. Medical records were reviewed with respect to age at presentation, extent of disease, laboratory data and bacteriology, associated disease, and clinical course. Also involved surface area was measured by the rule used in burn patients. Statistical analysis was made by Mann Whitney U test and Fisher's exact test. Results:Of 27 patients, 4 died and 23 survived. The mean age was 55.4±13.7. The most common underlying disease was diabetes mellitus. In comparison of survival and non-survival groups, there were significant differences in duration of symptom before hospitalization, total surface area involved, laboratory data including serum albumin, creatinine, and WBC count on CBC. However, there was no difference in hospital stay, age, underlying disease, serum BUN, infected organisms, and urinary or fecal diversion. Conclusion:We conclude that the unfavorable factors affecting survival are duration of symptom before hospitalization, total surface area involved, serum albumin and creatinine level, and WBC count on CBC. The survival was, however, not associated with bacteriological factors, hospital stay, age, urinary or fecal diversion, and underlying diseases such as diabetes, and cancer.
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