Department of Otorhinolaryngology-Head and Neck Surgery, University of Freiburg, Freiburg, Germany.
Ann Surg. 2010 Mar;251(3):528-34. doi: 10.1097/SLA.0b013e3181c1b0d1.
To evaluate contemporary trends in etiology, diagnosis, management, and outcome of descending necrotizing mediastinitis (DNM) and to draw the clinician's attention on this probably underappreciated disease.
An uncommon but one of the most serious forms of mediastinitis is DNM which is caused by downward spread of deep neck infections and arises as a major complication of "banal" odontogenic, pharyngeal, or cervicofacial foci. As most studies are based on small patient populations, current data on risk factors, etiology, and outcome vary significantly. Also, the optimal form of treatment remains controversial.
This retrospective study, which is the largest single-center study since 1960, is based on the management of 45 patients with DNM treated over a period of 12 years. Additionally, a meta-analysis of 26 studies on DNM published between 1999 and 2008 was performed and compared with own data and 2 previous meta-analyses covering the interval from 1960 to 1998.
Today DNM most commonly arises from pharyngeal foci and mixed polymicrobial aerobic and anaerobic infections. Reduced tissue oxygenation and impaired immune function promotes its development. Most cases of DNM are limited to the upper mediastinum and can be adequately drained by a transcervical approach. Formal thoracotomy should be reserved for cases extending below the plane of the tracheal bifurcation. Although DNM remains an aggressive infection with high morbidity, a favorable outcome can now be obtained in 85% of patients, even with this selective approach. Early diagnosis and surgical intervention are crucial.
评估下行性坏死性纵隔炎（DNM）的病因、诊断、治疗和预后的当代趋势，并引起临床医生对这种可能被低估的疾病的关注。
DNM 是一种罕见但最严重的纵隔炎形式之一，是由深部颈部感染向下蔓延引起的，是“普通”牙源性、咽源性或颈面部病灶的主要并发症。由于大多数研究基于小患者人群，因此有关危险因素、病因和结果的数据差异很大。此外，最佳治疗形式仍存在争议。
这项回顾性研究是自 1960 年以来最大的单中心研究，基于对 12 年间 45 例 DNM 患者的治疗。此外，还对 1999 年至 2008 年间发表的 26 篇关于 DNM 的研究进行了荟萃分析，并与自身数据和涵盖 1960 年至 1998 年期间的前 2 次荟萃分析进行了比较。
如今，DNM 最常见于咽源性病灶和混合需氧和厌氧的多微生物感染。组织氧合减少和免疫功能受损促进了其发展。大多数 DNM 局限于上纵隔，通过经颈入路即可充分引流。只有当病变延伸至气管分叉平面以下时，才应采用正式的开胸术。尽管 DNM 仍然是一种具有高发病率的侵袭性感染，但即使采用这种选择性方法，现在仍可使 85%的患者获得良好的预后。早期诊断和手术干预至关重要。
