颈部脓肿合并下行性坏死纵隔炎的诊断和治疗策略  

Diagnosis and Treatment Strategies for Neck Abscess with Descending Necrotizing Mediastinitis

作　　者：陈兴龙 胡纯红[1] CHEN Xinglong;HUChunhong(Department of Otorhinolaryngology Head and Neck Surgery,Second People's Hospital of Chengdu,Chengdu 610000,China)

机构地区：[1]四川省成都市第二人民医院耳鼻咽喉头颈外科,610000

出　　处：《实用心脑肺血管病杂志》2020年第S02期4-8,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的探究颈部脓肿合并下行性坏死纵隔炎(DNM)的临床特点、诊断及治疗策略,以期为该病防治提供依据。方法回顾性收集2015年6月—2019年12月成都市第二人民医院收治的14例颈部脓肿合并DNM患者的临床资料。结果颈部脓肿合并DNM男性多见(78.57%);中老年群体多发,≥60岁占35.71%;感染来源多为咽喉部感染(42.86%)及牙源性感染(28.57%);临床表现以咽喉痛、发热、胸闷气短、胸痛为主;CT分型为ⅡB型(64.29%)居多,合并糖尿病占28.57%;本组14例患者均依据CT分型选择外科清创+引流+抗菌药物治疗,痊愈12例(85.71%),住院时间(26.53±5.11)d,死亡率为14.29%;10例出现肺部感染,5例并发胸腔积液,3例伴心包积液,3例大面积皮下气肿及纵隔气肿,并发胸膜增厚2例,肝功能不全2例,并发急性胰腺炎、消化性溃疡并出血各1例。结论颈部脓肿合并DNM病情多危重,致死率高;颈胸部联合CT是早期筛查DNM有效手段;尽早确诊并及时切开清创、充分引流,配合对症支持、抗菌治疗是降低患者死亡率的关键。Objective To explore the clinical features,diagnosis and treatment strategies for neck abscess with descending necrotizing mediastinitis(DNM),with a view to providing a basis for prevention and treatment of the disease.Methods The clinical data of 14 patients with neck abscess and DNM who were admitted and treated in the hospital from June 2015 to December 2019 were collected retrospectively.Results Neck abscess with DNM was more common in males(78.57%).Most patients were middle-aged and elderly people of whom people aged or above 60 years old accounted for 35.71%.Throat infection(42.86%)and odontogenic infection(28.57%)were main infections.Sore throat,fever,chest tightness,shortness of breath and chest pain were main clinical manifestations.Patients with CT typeⅡB were the majority(64.29%),and those complicated with diabetes accounted for 28.57%.All the 14 patients in this study were treated with surgical debridement and drainage combined with antibacterial drugs,and 12 cases(85.71%)were cured.The length of hospital stay and mortality rate were(26.53±5.11)d and 14.29%.There were 10 cases with lung infection,5 cases with pleural effusion,3 cases with pericardial effusion,3 cases with large-area subcutaneous emphysema and mediastinal emphysema,2 cases with pleural thickening,2 cases with hepatic insufficiency,1 case complicated with acute pancreatitis and 1 case complicated with peptic ulcer.Conclusion Most patients with neck abscess complicated with DNM are critically ill and the fatality rate is high.Combined neck and chest CT is an effective method for early screening of DNM.Early diagnosis together with timely debridement and full drainage combined with symptomatic support and antibacterial treatment is essential to reduce the mortality rate.

关 键 词：下行性坏死纵隔炎 颈部脓肿 手术引流 电子计算机断层扫描 感染 

分 类 号：R564.2[医药卫生—呼吸系统]