下行性坏死性纵隔炎：一种使用电视辅助胸腔镜手术的微创方法。
Descending necrotizing mediastinitis: a minimally invasive approach using video-assisted thoracoscopic surgery.
作者信息
Min Ho-Ki, Choi Yong Soo, Shim Young Mog, Sohn Young Ick, Kim Jhingook
机构信息
Department of General Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
出版信息
Ann Thorac Surg. 2004 Jan;77(1):306-10. doi: 10.1016/s0003-4975(03)01333-x.
BACKGROUND
Descending necrotizing mediastinitis is a rare but serious disease. Aggressive surgical approaches have been emphasized rather than simple medical treatment.
METHODS
Four patients with descending necrotizing mediastinitis were treated surgically in our institution between January 2001 and August 2002. Three had peritonsilar abscesses and one had an odontogenic abscess. Operative procedures included drainage and debridement through a Chamberlain incision and neck incision using video-assisted thoracic surgery.
RESULTS
The mean duration from symptoms to operation was 5.3 days (range, 3 to 7) and mean hospital stay was 28.8 days (range, 14 to 47). There was no perioperative mortality. Postoperative complications were found in three patents: two with localized pleural effusion and one with a hydropneumothorax.
CONCLUSIONS
Video-assisted thoracic surgery is feasible and effective as a less invasive method for the surgical management of patients with descending necrotizing mediastinitis, especially when applied early.
背景
下行性坏死性纵隔炎是一种罕见但严重的疾病。一直强调采取积极的手术方法而非单纯的药物治疗。
方法
2001年1月至2002年8月间，我们机构对4例下行性坏死性纵隔炎患者进行了手术治疗。3例患有扁桃体周围脓肿，1例患有牙源性脓肿。手术操作包括通过张伯伦切口和颈部切口，使用电视辅助胸腔镜手术进行引流和清创。
结果
从症状出现到手术的平均时间为5.3天（范围3至7天），平均住院时间为28.8天（范围14至47天）。围手术期无死亡病例。3例患者出现术后并发症：2例有局限性胸腔积液，1例有血气胸。
结论
电视辅助胸腔镜手术作为一种侵入性较小的方法，对于下行性坏死性纵隔炎患者的手术治疗是可行且有效的，尤其是早期应用时。
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