下行性坏死性纵隔炎：系列外科清创术对患者死亡率影响的分析
Descending necrotizing mediastinitis: An analysis of the effects of serial surgical debridement on patient mortality.
作者信息
Freeman R K, Vallières E, Verrier E D, Karmy-Jones R, Wood D E
机构信息
Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, WA 98195-6310, USA.
出版信息
J Thorac Cardiovasc Surg. 2000 Feb;119(2):260-7. doi: 10.1016/S0022-5223(00)70181-4.
OBJECTIVES
Descending necrotizing mediastinitis is a polymicrobial infection originating in the oropharynx with previously reported mortality rates of 25% to 40%. This investigation reviews the effects of serial surgical drainage and debridement on the survival of patients with descending necrotizing mediastinitis.
METHODS
A retrospective review of patients from 1980 through 1998 with a diagnosis of descending necrotizing mediastinitis was performed. Their records were abstracted for personal demographics, hospital course, morbidity, and mortality. Also abstracted were all reports of patients with descending necrotizing mediastinitis published in English between 1970 and 1999.
RESULTS
We treated 10 patients in whom descending necrotizing mediastinitis was identified. The mean age of the patients was 38 years. They underwent a mean of 6 +/- 4 computed tomographic imaging studies, 4 +/- 1 transcervical drainage procedures, and 2 +/- 1 transthoracic drainage procedures. Three patients required abdominal exploration and 4 underwent tracheostomy. No deaths occurred. In contrast, 96 patients with descending necrotizing mediastinitis were identified from the literature with a mean age of 38 years. They underwent a mean of 2 +/- 1 computed tomographic imaging studies, 2 +/- 1 transcervical drainage procedures, and 0.7 + 0.3 transthoracic drainage procedures. Sixteen (17%) patients required abdominal exploration and 34 (35%) underwent tracheostomy. Twenty-eight (29%) patients from the literature cohort died during their treatment.
CONCLUSION
Descending necrotizing mediastinitis remains a life-threatening infection. On the basis of experience accrued in treating these patients, an algorithm incorporating computed tomographic imaging for diagnosis and surveillance and serial transcervical and transthoracic operative drainage is outlined in the hope of reducing the excessive mortality of descending necrotizing mediastinitis.
目的
下行性坏死性纵隔炎是一种源于口咽的多微生物感染，先前报道的死亡率为25%至40%。本研究回顾了系列外科引流和清创术对下行性坏死性纵隔炎患者生存的影响。
方法
对1980年至1998年诊断为下行性坏死性纵隔炎的患者进行回顾性研究。提取他们的个人人口统计学、住院过程、发病率和死亡率记录。还提取了1970年至1999年期间以英文发表的所有下行性坏死性纵隔炎患者的报告。
结果
我们治疗了10例确诊为下行性坏死性纵隔炎的患者。患者的平均年龄为38岁。他们平均接受了6±4次计算机断层扫描成像检查、4±1次经颈引流手术和2±1次经胸引流手术。3例患者需要进行腹部探查，4例接受了气管切开术。无死亡病例。相比之下，从文献中识别出96例下行性坏死性纵隔炎患者，平均年龄为38岁。他们平均接受了2±1次计算机断层扫描成像检查、2±1次经颈引流手术和0.7±0.3次经胸引流手术。16例（17%）患者需要进行腹部探查，34例（35%）接受了气管切开术。文献队列中的28例（29%）患者在治疗期间死亡。
结论
下行性坏死性纵隔炎仍然是一种危及生命的感染。基于治疗这些患者积累的经验，概述了一种算法，该算法纳入计算机断层扫描成像用于诊断和监测以及系列经颈和经胸手术引流，以期降低下行性坏死性纵隔炎过高的死亡率。
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