Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre of Grenoble, Grenoble, France.
Br J Surg. 2010 Apr;97(4):609-15. doi: 10.1002/bjs.6935.
Cervical necrotizing fasciitis (CNF) associated with descending necrotizing mediastinitis (DNM) is a rapidly evolving and life-threatening condition. The aim of this retrospective study was to describe a treatment strategy for CNF with DNM and present a management algorithm for mediastinal extensions of CNF.
Patients diagnosed and treated for CNF with DNM over 14 years in a tertiary referral centre were included.
Seventeen adult patients were included. The origin of infection was mainly oropharyngeal. The diagnosis of CNF/DNM was based on clinical and computed tomography findings. All patients underwent cervicotomy for CNF. In ten patients, DNM was located above the carina and could be accessed by a cervical approach. In seven patients, DNM was below the carina, and necessitated sternotomy for anteroinferior mediastinal involvement and posterolateral thoracotomy for posteroinferior mediastinal involvement. All patients received broad-spectrum antibiotics. One patient died 3 days after surgery. The median hospital stay was 30 days. There was no recurrence during long-term follow-up.
Prompt diagnosis and early surgical treatment are essential for reducing mortality in CNF/DNM. All patients should undergo extensive cervicotomy. The surgical approach to the mediastinum depends on the supracarinal or infracarinal location of the disease.
与下行性坏死性纵隔炎（DNM）相关的颈坏死性筋膜炎（CNF）是一种迅速发展且危及生命的疾病。本回顾性研究旨在描述 CNF 伴 DNM 的治疗策略，并提出 CNF 纵隔延伸的处理算法。
在一家三级转诊中心，对 14 年来诊断和治疗 CNF 伴 DNM 的患者进行了研究。
共纳入 17 例成年患者。感染源主要为口咽。CNF/DNM 的诊断基于临床和计算机断层扫描发现。所有患者均行颈切开术治疗 CNF。10 例患者的 DNM 位于隆突上方，可通过颈入路触及。7 例患者的 DNM 位于隆突以下，需要胸骨切开术治疗前下纵隔受累，后外侧开胸术治疗后下纵隔受累。所有患者均接受了广谱抗生素治疗。1 例患者术后 3 天死亡。中位住院时间为 30 天。长期随访中无复发。
及时诊断和早期手术治疗对于降低 CNF/DNM 的死亡率至关重要。所有患者均应行广泛颈切开术。纵隔的手术入路取决于疾病的隆突上或隆突下位置。
