牙源性下行性坏死性纵隔炎的临床总结  

Odontogenic Descending Necrotizing Mediastinitis: Report of 5 Cases

作　　者：童永青[1] 陈申国[1] 戴杰[1] 施更生[1] 叶中瑞[2] 朱蔚[3] 

机构地区：[1]温州医学院附属台州医院口腔颌面外科,浙江台州317000 [2]温州医学院附属台州医院心胸外科,浙江台州317000 [3]温州医学院附属台州医院重症医学科,浙江台州317000

出　　处：《口腔颌面外科杂志》2014年第1期56-59,共4页Journal of Oral and Maxillofacial Surgery

摘　　要：目的：总结牙源性下行性坏死性纵隔炎的临床表现、发病机制、诊断和治疗方法，以提高该病的早期诊断率及治愈率。方法：回顾分析了5例牙源性坏死性纵隔炎的临床资料，男2例．女3例．平均年龄54．6岁。病因分析，下颌智齿冠周炎3例，上、下颌磨牙根尖脓肿各1例。均据临床表现、脓液细菌培养、CT等检查明确诊断。积极采用经颈或联合颈胸手术切开引流，其中经颈切开引流3例，应用胸腔镜行胸部引流2例。同时进行全身抗感染、营养支持等治疗。结果：5例患者经及时手术和药物治疗，出院前复查胸部CT，显示纵隔恢复正常，均痊愈出院．住院时间23～51d，平均29．2d。结论：牙源性下行性坏死性纵隔炎的病情发展迅速．早期确诊、及时切开引流是治疗成功的关键。Objective： To review and summarize the clinical characteristics and treatment outcomes of odontogenic descending necrotizing mediastinitis （ODNM）. Methods： Five ODNM patients were retrospectively analyzed. 2 males and 3 females with a median age of 54.6 years. 3 patients had mandibular wisdom teeth pericoronitis and 2 patients had periapical abcess of molars. The diagnosis measures included clinical examination, CT scan, and bacteriological culture. Treatments consisted of antibiotic administration and aggressive transcervial （3 cases） and/or transthoracic surgical mediastiual drainage （2 cases） . Patients hospitalized from 23 to 51 days, and the average stay was 29.2 days. Results： All patients achieved satisfactory recovery. Conclusion： Diagnosis without delay and aggressive surgical mediastinal drainage are significant in control of ODNM.

关 键 词：牙源性 下行性坏死性纵隔炎 外科引流 诊断 治疗 

分 类 号：R766[医药卫生—耳鼻咽喉科]