顔面，頸部ガス壊疽が生じた透析患者の1症例

A case of gas gangrene in the face and neck region of a dialyzed patient

Ⅰ．はじめに

　ガス壊疽とはガス産生を伴う壊疽性の軟部組織感染症のことであり，起炎菌により嫌気性グラム陽性桿菌であるクロストリジウム性とそれ以外の非クロストリジウム性に分けられる^1,2）。今回われわれは透析中という易感染性の状態を背景に，顔面と頸部にガス産生を伴う皮膚の進行性壊死をきたした非クロストリジウム性ガス壊疽を経験した。非クロストリジウム性ガス壊疽の頭頸部領域における発生率は低いものの致死率は比較的高く^2,3），早期の診断と早急な治療が重要である。自験例における治療経験を若干の文献的考察を加えて報告する。

　Gas gangrene is an inflammation of the soft tissue which causes gas formation. The patient was a 65-year-old woman undergoing hemodialysis since 2001. Her chief compliants were toothache and swelling of the cheek with gas formation revealed by the CT scan. On the fifth day from the onset, the skin of the cheek started to disintegrate. We diagnosed this case as gas gangrene caused by odontogenic infectin. We performed an emergency operation including extensive incision, drainage and debridement. Postoperatively, she had an extensive defect in the face and neck region. For that defect, several kinds of external drugs were applied with succefful results.