急性坏死性纵隔炎176例临床特征及转归的回顾性队列研究  

Clinical characteristics and outcomes of 176 patients with acute necrotizing mediastinitis:A retrospective cohort study

作　　者：梁林川 彭智愚 林华杭 周柯 梅建东[1] LIANG Linchuan;PENG Zhiyu;LIN Huahang;ZHOU Ke;MEI Jiandong(Department of Thoracic Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院胸外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2024年第2期243-248,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家重点研发项目(2018YFC2001800)。

摘　　要：目的分析急性坏死性纵隔炎临床特征、诊断和治疗转归,为临床诊疗提供参考。方法回顾性分析四川大学华西医院2012年3月—2021年4月期间收治的急性坏死性纵隔炎患者的临床资料,包括病因、临床表现、影像学资料、病原学结果、手术方式及转归,分析其发病特点、临床诊疗方法及预后因素。结果共纳入176例患者,中位年龄60(0~84)岁,男124例、女52例。最常见的感染来自颈部(66例,37.5%),最常见的临床表现是发热(85例,48.3%),脓液培养中以星座链球菌最常见(23例,13.1%)。本组患者中119例(67.6%)接受手术治疗,单纯颈部入路54例(30.7%)、单纯胸部入路27例(15.3%)[开胸9例(5.1%)、胸腔镜18例(10.2%)]、颈部+胸部入路37例(21.0%)[开胸7例(4.0%)、胸腔镜30例(17.0%)]、剑突下入路1例(0.6%)。176例患者中治愈出院144例(81.8%),死亡32例(18.1%)。多因素分析显示年龄调整后Charlson合并症指数(OR=2.95,P=0.022)、围术期存在脓毒症(OR=2.84,P=0.024)、未行外科手术引流(OR=2.41,P=0.043)是患者死亡的独立预测因素。结论临床疑诊急性坏死性纵隔炎的患者应行影像学检查明确脓肿累及范围,以指导手术入路的选择,对于诊断明确的患者尽早行手术治疗,及时清除感染组织、充分引流。年龄调整后Charlson合并症指数、围术期存在脓毒症以及未行外科手术引流与患者的预后不良密切相关。Objective To investigate the etiology,symptoms,diagnosis,surgical treatment,and outcomes of acute necrotizing mediastinitis(ANM)in order to guide future diagnosis and treatment of ANM.Methods The clinical data of patients with ANM referred to West China Hospital,Sichuan University from March 2012 to April 2021 were retrospectively analyzed.The etiology,clinical manifestations,demographic characteristics,bacterial culture results,surgical approach and prognostic factors of these patients were summarized.Results A total of 176 patients were enrolled in this study.The median age was 60(0-84)years.There were 124(70.5%)males and 52(29.5%)females.The most common origin of infection was neck(n=66,37.5%).The most common symptom was fever(n=85,48.3%).Streptococcus constellatus represented the most common pathogens in secretion culture.Surgical treatment was administered to 119(67.6%)patients through different approaches,including 54(30.7%)patients of cervical approach,9(5.1%)patients of thoracotomy,18(10.2%)patients of video-assisted thoracoscopic surgery(VATS),7(4.0%)patients of cervical combined with thoracotomy,30(17.0%)patients of cervical combined with VATS,and 1(0.6%)patient of subxiphoid approach.Among this cohort,144(81.8%)patients were cured,while 32(18.1%)patients died.Age-adjusted Charlson comorbidity index(OR=2.95,P=0.022),perioperative sepsis(OR=2.84,P=0.024),and non-surgical treatment(OR=2.41,P=0.043)were identified as independent predictors of poor outcomes.Conclusion For patients with corresponding history and manifestations of ANM,it is crucial to go through imaging examination to confirm the presence of an abscess and guide the selection of surgical approach.Once the diagnosis of ANM is made,it is imperative to promptly perform surgical intervention for effective drainage.Our study highlights the significance of age-adjusted Charlson comorbidity index,perioperative sepsis and surgical treatment in predicting patients’outcomes.

关 键 词：急性坏死性纵隔炎 临床特征 病原学 手术 转归 

分 类 号：R655.5[医药卫生—外科学]