Rudack C, Eikenbusch G, Stoll W, Hermann W
HNO-Klinik, Universitätsklinikum Muenster.
HNO. 2003 Dec;51(12):986-92. doi: 10.1007/s00106-003-0854-6.
Necrotizing neck infections are uncommon soft-tissue infections, usually caused by virulent, toxin producing bacteria. Necrotizing fasciitis represents a special form of necrotizing soft tissue infection with a mortality rate of up to 76% even though aggressive therapy is recommended.
In the last 2 years we treated four patients with severe necrotizing neck infections and five suffering from necrotizing fasciitis.
Microbiological analysis revealed mixed infections with Candida albicans, Streptococcus pyogenes, Fusobacterium, Proprioni bacteria and Staphylococcus. The surgical management was not only restricted to drainage, but also included functional neck dissection in order minimize the spread of the disease. Eight of our patients recovered completely, but one died due to toxic shock as consequence of a delayed in therapy.
Complete recovery of patients suffering from necrotizing fasciitis depends on early and aggressive surgical therapy including neck dissection and drainage as well as an interdisciplinary strategy of conservative therapy. Hyperbaric oxygen should be considered as a treatment adjunct in patients with necrotizing fasciitis if surgery and antibiotic treatment fail.
颈部坏死性感染是一种罕见的软组织感染，通常由具有毒性、产生毒素的细菌引起。坏死性筋膜炎是坏死性软组织感染的一种特殊形式，即使推荐采用积极治疗，其死亡率仍高达76%。
在过去两年中，我们治疗了4例严重颈部坏死性感染患者和5例坏死性筋膜炎患者。
微生物学分析显示为白色念珠菌、化脓性链球菌、梭杆菌、丙酸杆菌和葡萄球菌的混合感染。手术治疗不仅限于引流，还包括功能性颈部清扫术，以尽量减少疾病的传播。我们的8例患者完全康复，但1例因治疗延误导致中毒性休克死亡。
坏死性筋膜炎患者的完全康复取决于早期积极的手术治疗，包括颈部清扫和引流以及保守治疗的多学科策略。如果手术和抗生素治疗失败，高压氧应被视为坏死性筋膜炎患者的辅助治疗手段。
