푸르니에 괴저의 치료에서 일시적 결장루를 대체한 변우회용 기구의 적용 (Application of BMSTM Avoids a Defunctioning Colostomy in the Treatment of Fournier's Gangrene)

서지정보

· 발행기관 : 대한대장항문학회
· 수록지 정보 : Annals of Coloproctolgy / 24권 / 2호 / 137 ~ 143페이지
· 저자명 : 손대호, 정상훈, 심민철, 김재황

초록

Recently developed BMSTM (Zassi Bowel Management SystemTM: Hollister Inc., Illinois, USA) can provide effective nonsurgical fecal diversion without the risks associated with colostomy creation and subsequent closure. Our aim is to evaluate the effectiveness of the BMS in diverting feces from the perianal wide surgical wound in patients with Fournier's gangrene. Methods: BMSTM was applied in five patients (male: 2, median age; 44) with Fournier's gangrene from January 2000 to September 2001. The treatments consist of three times a day wound dressing after wide surgical debridement and intravenous antibiotic therapy. For evacuation of feces, twice daily warm saline irrigation was administered via BMSTM or low daily doses of polyethylene glycol solutions were orally taken in. An endoscopic and anorectal manometric study was done to evaluate possible mucosal complications and anorectal functional changes. Results: The average duration of the BMS application was 41 (range, 22∼63) days. The result of a manometric study after immediate removal of the BMSTM showed a decreased mean resting pressure (range: 22∼36 mmHg) and a decreased mean squeezing pressure (range: 32∼39 mmHg). After 3 days, the sphincter pressure had improved markedly: mean resting pressures of 38, 45, 60, and 63 mmHg and mean squeezing pressure of 78, 89, 91, and 101 mmHg respectively. Fecal incontience was not noted in any patient. Other possible mucosal complications were not noted. There were no mortalit. Conclusions: BMSTM application in Fournier's gangrene patients after surgery successfully avoids a defunctioning colostomy. Furthermore, no significant complications were noted over a prolonged period up to 63 days.

영어초록

Recently developed BMSTM (Zassi Bowel Management SystemTM: Hollister Inc., Illinois, USA) can provide effective nonsurgical fecal diversion without the risks associated with colostomy creation and subsequent closure. Our aim is to evaluate the effectiveness of the BMS in diverting feces from the perianal wide surgical wound in patients with Fournier's gangrene. Methods: BMSTM was applied in five patients (male: 2, median age; 44) with Fournier's gangrene from January 2000 to September 2001. The treatments consist of three times a day wound dressing after wide surgical debridement and intravenous antibiotic therapy. For evacuation of feces, twice daily warm saline irrigation was administered via BMSTM or low daily doses of polyethylene glycol solutions were orally taken in. An endoscopic and anorectal manometric study was done to evaluate possible mucosal complications and anorectal functional changes. Results: The average duration of the BMS application was 41 (range, 22∼63) days. The result of a manometric study after immediate removal of the BMSTM showed a decreased mean resting pressure (range: 22∼36 mmHg) and a decreased mean squeezing pressure (range: 32∼39 mmHg). After 3 days, the sphincter pressure had improved markedly: mean resting pressures of 38, 45, 60, and 63 mmHg and mean squeezing pressure of 78, 89, 91, and 101 mmHg respectively. Fecal incontience was not noted in any patient. Other possible mucosal complications were not noted. There were no mortalit. Conclusions: BMSTM application in Fournier's gangrene patients after surgery successfully avoids a defunctioning colostomy. Furthermore, no significant complications were noted over a prolonged period up to 63 days.

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