[导致下行性坏死性纵隔炎的头颈部感染：9例病例的处理]
[Infections of the head and neck leading to descending necrotizing mediastinitis: management of 9 cases].
作者信息
Lin Chong-xiang, Ding Xi, Ma Yi-ke, Zhang Xue-fei, Zhu Xing-hao
机构信息
Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou Zhejiang 325000, China.
出版信息
Zhonghua Kou Qiang Yi Xue Za Zhi. 2009 Oct;44(10):619-20.
OBJECTIVE
To report nine cases of descending necrotizing mediastinitis (DNM) and to summarize the management experience.
METHODS
Between December 2005 and December 2008, nine patients (mean age, 55.7 years; age range, 38 to 78 years) with DNM were treated. Eight patients underwent surgical drainage of the involved cervical region and mediastinum (4 with cervical drainage alone; 4 with cervical drainage and right thoracotomy).
RESULTS
Two patients died, one of them refused surgical therapy and the other one died of multiorgan failure related to postoperative septic shock. Seven patients recovered. The mortality rate was 22%.
CONCLUSIONS
Delayed diagnosis and inadequate drainage are the main causes of high mortality rate of DNM. Aggressive surgical drainage and debridement of the neck and mediastinum by a multidisciplinary team of surgeons are very important in the treatment of DNM.
目的
报告9例降主动脉坏死性纵隔炎（DNM）病例并总结治疗经验。
方法
2005年12月至2008年12月，对9例DNM患者（平均年龄55.7岁；年龄范围38至78岁）进行治疗。8例患者接受了受累颈部区域和纵隔的手术引流（4例仅行颈部引流；4例行颈部引流及右开胸手术）。
结果
2例患者死亡，1例拒绝手术治疗，另1例死于与术后感染性休克相关的多器官功能衰竭。7例患者康复。死亡率为22%。
结论
诊断延迟和引流不充分是DNM高死亡率的主要原因。由多学科外科团队积极进行颈部和纵隔的手术引流及清创在DNM的治疗中非常重要。
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