颈部双平行切口联合纵隔镜或胸腔镜治疗颈部坏死性筋膜炎伴下行性坏死性纵隔炎的临床初探  

Clinical study of cervical necrotizing fasciitis accompanied with descending necrotizing mediastinitis treated with cervical double parallel incision combined with mediastinoscope or thoracoscope

作　　者：朱志超[1] 杨旭[1] 郑峰[2] 郑亮[3] 徐天舒[1] Zhu Zhichao;Yang Xu;Zheng Feng;Zheng Liang;Xu Tianshu(Department of Stomatology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou 213000, China;Intensive Care Unit, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochoiv University, Changzhou 213000. China;Department of Thoracic Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University. Changzhou 213000, China)

机构地区：[1]常州市第一人民医院苏州大学附属第三医院口腔科,213000 [2]常州市第一人民医院苏州大学附属第三医院重症医学科,213000 [3]常州市第一人民医院苏州大学附属第三医院胸外科,213000

出　　处：《中华口腔医学杂志》2019年第5期309-314,共6页Chinese Journal of Stomatology

摘　　要：目的总结颈部双平行切口联合纵隔镜或胸腔镜治疗颈部坏死性筋膜炎(cervical necrotizing fasciitis,CNF)伴下行性坏死性纵隔炎(descending necrotizing mediastinitis,DNM)的治疗经验,以期为临床提供参考。方法回顾性分析2014年9月至2018年9月常州市第一人民医院口腔科和耳鼻咽喉头颈外科收治的6例CNF伴DNM患者的临床资料,其中男性2例,女性4例,年龄48~73岁,均由颈胸部CT检查确诊。3例患者在全身麻醉下行颈部双平行切口联合纵隔镜下颈胸联合引流,另3例在全身麻醉下行颈部双平行切口联合胸腔镜下颈胸联合引流,术后复查颈胸部CT和血常规、C反应蛋白、降钙素原等感染性指标。结果6例患者颈胸联合引流通畅,未行二次手术,感染性指标逐渐下降;术后第1天可下床活动,平均住院21d(16~36d)后均痊愈出院,术后平均随访18个月(4~30个月),感染未复发,患者对颈部切口外观满意。结论颈部双平行切口联合纵隔镜或胸腔镜治疗CNF伴DNM,引流彻底,创伤小,效果佳,术区美观,值得临床推广。Objective To summarize the experience of applying cervical double parallel incision combined with mediastinoscope or thoracoscope in the treatment of cervical necrotizing fasciitis (CNF)accompanied with descending necrotizing mediastinitis (DNM),so as to provide a reference for clinical practice.Methods The clinical data of six patients with CNF accompanied with DNM who were admitted to the Department of Stomatology and the Department of Otolaryngology Head and Neck Surgery,The First People's Hospital of Changzhou from September 2014 to September 2018 were retrospectively analyzed.All of the six patients were confirmed by CT of neck and chest,among whom there were two males and four females aged from 48 to 73.Three patients were treated with cervical double parallel incision combined with mediastinoscope to be combined with cervical and thoracic drainage under general anesthesia while the other three with cervical double parallel incision combined with thoracoscope to be combined cervical and thoracic drainage under general anesthesia.The CT of neck and chest as well as infectious indicators including hematology,C-reactive protein (CRP) and procalcitonin (PCT) were reexamined during the postoperative period.Results The cervical and thoracic combined drainage was unobstructed in all of the six patients,no secondary surgery was performed,and the infectious indicators gradually decreased.All patients had off-bed activities on the first day after the operation,were all cured and discharged after an average of 21 days (16 to 36 days) in hospital and followed up for an average of 18 months (4 to 30 months)after the operation.None of them experienced infection relapse,and they were all satisfied with the appearance of the cervical incision.Conclusions Cervical double parallel incision combined with mediastinoscope or thoracoscope for the treatment of CNF accompanied with DNM has the advantages of complete drainage,small trauma,excellent efficacy and aesthetic operative area,thus being deserved to be clinically populariz

关 键 词：筋膜炎 坏死性 纵隔炎 引流术 胸腔镜 纵隔镜 

分 类 号：R653[医药卫生—外科学]