Mao Johnny C, Carron Michael A, Fountain Kimberly R, Stachler Robert J, Yoo George H, Mathog Robert H, Coticchia James M
Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Am J Otolaryngol. 2009 Jan-Feb;30(1):17-23. doi: 10.1016/j.amjoto.2007.12.007. Epub 2008 Jul 10.
First objective was to review cases of craniocervical necrotizing fasciitis (CCNF) at Wayne State University/Detroit Medical Center (Detroit, MI) for the last 18 years. Second was to analyze patients with and without thoracic extension for contributing factors.
Retrospective review of 660 patients with necrotizing fasciitis treated at WSU/DMC from January 1989 to January 2007 was conducted. Data regarding source/extent of infection, presenting signs/symptoms, computed tomography, microbiology, antibiotics, comorbidities, number/type of operations, hyperbaric oxygen (HBO) therapy, hospital duration, complications, and overall outcome were compared/analyzed between patients with and without thoracic extension.
Twenty patients with CCNF for the past 18 years met the inclusion criteria. Ten patients had thoracic extension, and 10 patients did not have. Individuals in the thoracic extension group were likely to be older, had increased comorbidity, required more surgical debridement, experienced increased postoperative complications, and had lower overall survival. Three patients with thoracic extension underwent HBO therapy and 66% survived.
This is the largest single institutional review of CCNF comparing patients with and without thoracic extension. Patients with thoracic extension have a poorer outcome as follows: 60% (6/10) survival vs 100% (10/10) for those without thoracic extension (P < .05). The CCNF patients without thoracic extension treated at our institution all survived after prompt medical and surgical intervention. Overall survival of CCNF patients without thoracic extension may be attributed to rigorous wound care, broad spectrum intravenous antibiotics, aggressive surgical debridement, and vigilant care in surgical intensive care unit. The HBO therapy should be included if the patient can tolerate it.
首要目标是回顾韦恩州立大学/底特律医疗中心（密歇根州底特律）过去18年的颅颈坏死性筋膜炎（CCNF）病例。其次是分析有和没有胸段扩展的患者的促成因素。
对1989年1月至2007年1月在韦恩州立大学/底特律医疗中心接受治疗的660例坏死性筋膜炎患者进行回顾性研究。比较/分析有和没有胸段扩展的患者之间关于感染源/范围、出现的体征/症状、计算机断层扫描、微生物学、抗生素、合并症、手术次数/类型、高压氧（HBO）治疗、住院时间、并发症和总体结果的数据。
过去18年中有20例CCNF患者符合纳入标准。10例患者有胸段扩展，10例患者没有。胸段扩展组的患者年龄可能更大，合并症更多，需要更多的手术清创，术后并发症增加，总体生存率更低。3例有胸段扩展的患者接受了HBO治疗，66%存活。
这是对CCNF进行的最大规模的单机构回顾，比较了有和没有胸段扩展的患者。有胸段扩展的患者预后较差，如下所示：生存率为60%（6/10），而没有胸段扩展的患者为100%（10/10）（P <.05）。在我们机构接受治疗的没有胸段扩展的CCNF患者在及时的药物和手术干预后全部存活。没有胸段扩展的CCNF患者的总体生存可能归因于严格的伤口护理、广谱静脉抗生素、积极的手术清创以及在外科重症监护病房的密切护理。如果患者能够耐受，应包括HBO治疗。
