急性期扁桃体切除治疗扁桃体周围脓肿致颈深间隙感染的诊治  

Diagnosis and treatment experience of tonsillectomy in acute phase for deep cervical space infection by peritonsillar abscess

作　　者：刘茉[1] 王洵[1] 王彦君[1] 葛鑫颖 夏菲[1] 任媛媛[1] 王宁宇[1] LIU Mo;WANG Xun;WANG Yanjun;GE Xinying;XIA Fei;REN Yuanyuan;WANG Ningyu(Department of Otolaryngology Head and Neck Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing,100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院耳鼻咽喉头颈外科,北京100020

出　　处：《中国耳鼻咽喉头颈外科》2023年第6期388-392,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨扁桃体周围脓肿致颈深间隙感染的诊断与治疗。方法回顾性分析6例扁桃体周围脓肿致颈深间隙感染患者的临床特征、影像学检查、治疗措施和预后情况。结果6例患者均为男性,均行颈部CT平扫,示扁桃体周围软组织肿胀,间隙消失,其中2例颈深间隙出现积气征。白细胞(WBC)计数、C反应蛋白(CRP)及降钙素原(PCT)等感染指标均明显增高。6例患者均行低温等离子患侧扁桃体切除术,其中2例因喉梗阻行气管切开术;1例脓肿扩散至上纵隔,加行颈侧切开引流术。6例患者均治愈出院。结论扁桃体周围脓肿致颈深间隙感染,病情危重。颈部CT是首选的辅助检查,结合WBC计数、CRP和PCT等动态变化,可指导治疗。对于切开引流治疗效果欠佳,或者合并糖尿病控糖效果不佳的患者,可考虑急性期行患侧扁桃体切除,去除感染病灶尽早暴露脓腔,引流脓液,并联合有效的抗感染治疗是成功的关键。OBJECTIVE To inquire into the diagnosis and treatment of deep cervical space infection caused by peritonsillar abscess.METHODS The clinical features,radiological images,treatment methods,and prognosis of 6 patients with deep cervical space infection caused by peritonsillar abscess were analyzed retrospectively.RESULTS All 6 patients were male.The neck-area CT scan images indicate that the soft tissue around the tonsils was swollen to the degree that the cervical space disappeared,among whom there are 2 patients with pneumatosis signs.Leucocyte count,C-reactive protein,and procalcitonin significantly increased.6 patients underwent coblation tonsillectomy on the affected side,of which 2 patients underwent tracheotomy due to laryngeal obstruction and 1 case of abscess spread to the upper mediastinum and underwent lateral cervical incision and drainage.All 6 patients were cured and discharged from the hospital.CONCLUSION The infection of deep cervical space caused by peritonsillar abscess could have severe consequences.The CT scan of the neck area is the first choice for auxiliary examination,combined with the indicators including leucocyte count,C-reactive protein,and procalcitonin,could instruct next-step treatment.For the patients whose drainage didn't achieve expected result or diabetic patients whose blood glucose were unsatisfying,tonsillectomy should be timely performed to remove the infected lesions,and expose the pus cavity as soon as possible.Effective drainage and anti-infection treatment are the crucial to success.

关 键 词：扁桃体切除术 诊断 治疗结果 扁桃体周围脓肿 颈深间隙感染 

分 类 号：R766.9[医药卫生—耳鼻咽喉科]