Гангрена Фурнье — мультидисциплинарная проблема гнойно-септической хирургии

Статья посвящена актуальной проблеме гнойно-септической хирургии, в ней представлен аналитический обзор систематической литературы, освещающей одну из редких форм некротизирующего фасциита — гангрену Фурнье. С позиции эволюционного подхода изложены исторические вехи формирования научных взглядов на сущность и этиопатогенез болезни, ее эпидемиологию, классификацию, клинику, диагностику и лечение. В контексте дефиниции декларировано, что в современном представлении под понятием «гангрена Фурнье» подразумевается частная (специфическая) модель критических состояний в хирургии, которая характеризуется прогрессирующим гнойно-некротическим поражением и гнилостным распадом фасциальных и мягкотканных структур наружных половых органов, манифестирующих явлениями системного эндотоксикоза, септического шока и высокой летальностью. Постулировано, что в основе патогенетического механизма развития гангрены Фурнье лежит внутрисосудистая инвазия каузативной микрофлоры, следствием которой является диссеминированный тромбоз микроциркуляторного русла поверхностной фасции мошонки. В соответствии с принципами доказательной медицины изложены современные методы диагностики и лечения. Показано, что приоритетом в лечении больных с гангреной Фурнье является неотложное оперативное вмешательство в формате «агрессивной хирургии», главной составляющей которой считается «рукотворная элиминация» некротизированных и нежизнеспособных тканей, достигаемая программированной (этапной) санационной некрэктомией. Рассмотрены вопросы адъювантной терапии с использованием методов лазерной санации, вакуум-терапии раны и гипербарической оксигенации. На основании многофакторного анализа данных современной литературы декларировано, что важным условием, всецело влияющим на исход лечения и прогноз болезни, является мультидисциплинарный подход к решению диагностических и лечебно-тактических задач с участием врачей смежных специальностей (хирурга, колопроктолога, уролога. дерматолога, реаниматолога, радиолога, бактериолога).

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