Deu-Martín María, Saez-Barba Manel, López Sanz Iker, Alcaraz Peñarrocha Rosa, Romero Vielva Laura, Solé Montserrat Joan
Servicio de Cirugía Torácica, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
Arch Bronconeumol. 2010 Apr;46(4):182-7. doi: 10.1016/j.arbres.2010.01.008. Epub 2010 Mar 15.
The term descending necrotizing mediastinitis (MND) refers to an infection that begins in the oropharyngeal region and spreads through the fascial planes into the mediastinum. This study aims to estimate the incidence of MND in our centre, the epidemiology and clinical features of the disease and to evaluate prognostic factors influencing mortality.
We performed a retrospective study on 43 consecutive patients diagnosed at the Hospital Universitari Vall d'Hebron in Barcelona from January 1996 to December 2006. We performed a descriptive study and a bivariate and a multivariate analysis of variables collected.
Overall mortality was 21%, but when we subdivided the study into two periods (1996-2000 and 2001-2006) it shows a significant decrease (40% versus 4.3%). Risk factors identified in the bivariate analysis were: diagnosis period 1996-2000, diabetes mellitus, comorbidity, number of surgeries, left lateral surgery, postoperative morbidity and septic shock. In multivariate analysis, only the presence of septic shock proved to be an independent predictor of mortality.
MND is a disease of low incidence and should be suspected clinically and confirmed immediately with a computed tomography (CT). Multidisciplinary and early treatment has allowed us to reduce mortality by 40% in the first initial period to 4.3% today.
下行性坏死性纵隔炎（MND）是指始于口咽区域并通过筋膜平面蔓延至纵隔的感染。本研究旨在评估我院MND的发病率、该疾病的流行病学和临床特征，并评估影响死亡率的预后因素。
我们对1996年1月至2006年12月在巴塞罗那的瓦尔德希伯伦大学医院连续诊断的43例患者进行了回顾性研究。我们对收集到的变量进行了描述性研究、双变量分析和多变量分析。
总体死亡率为21%，但当我们将研究分为两个时期（1996 - 2000年和2001 - 2006年）时，死亡率显著下降（40%对4.3%）。双变量分析确定的危险因素为：1996 - 2000年诊断期、糖尿病、合并症、手术次数、左侧手术、术后发病率和感染性休克。多变量分析中，只有感染性休克被证明是死亡率的独立预测因素。
MND是一种发病率较低的疾病，临床上应予以怀疑，并立即通过计算机断层扫描（CT）确诊。多学科早期治疗使我们能够将最初阶段的死亡率从40%降至如今的4.3%。
