Hoffmann C, Pierrot S, Contencin P, Morisseau-Durand M-P, Manach Y, Couloigner V
Pediatric ENT Department, Hôpital Necker - Enfants Malades, AP-HP, University of Paris V, France.
Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1099-103. doi: 10.1016/j.ijporl.2011.05.024. Epub 2011 Jun 25.
To optimize the treatment of retropharyngeal infections in children.
Retrospective chart review of 101 consecutive pediatric cases of retropharyngeal infections referred to our center from January 2006 to July 2009.
Two-thirds of patients were males. Their mean age was 52 months (range: 6-163). Upper airway obstruction was observed in three patients. In another child, the infection evolved towards a diffuse cervical cellulitis. Medical treatment was initially planned in 44% of patients. Failures requiring surgical drainage occurred in 18% of them. In 56% of cases, surgical treatment was immediately instigated. It failed in 16% of patients, requiring a second surgical drainage. There was no difference in the duration of fever and of hospital stay between patients initially treated medically or surgically. Both medical and surgical treatment failures were associated with longer durations of fever (p=0.002, and p<0.0001, respectively) and of hospital stay (p=0.0006, and p=0.0005, respectively). Some characteristics of CT-scan anomalies were correlated with treatment failure. A hypodense core surrounded by rim enhancement, with a largest long axis ≥ 20 mm, was more frequent in case of medical failure (p=0.02). Surgical failure was associated with the same feature, but with a largest long axis ≥ 30 mm (p=0.05).
The present study suggests that severe complications are rare in pediatric retropharyngeal adenitis, and that CT-scan is a useful tool to choose between medical and surgical treatment.
优化儿童咽后感染的治疗方法。
回顾性分析2006年1月至2009年7月间转诊至本中心的101例连续性儿童咽后感染病例。
三分之二的患者为男性。他们的平均年龄为52个月（范围：6 - 163个月）。3例患者出现上呼吸道梗阻。另一名儿童的感染发展为弥漫性颈部蜂窝织炎。最初计划对44%的患者进行药物治疗。其中18%的患者因治疗失败需要手术引流。56%的病例立即进行了手术治疗。16%的患者手术失败，需要再次进行手术引流。最初接受药物治疗或手术治疗的患者在发热持续时间和住院时间上没有差异。药物治疗和手术治疗失败均与更长的发热持续时间（分别为p = 0.002和p < 0.0001）和住院时间（分别为p = 0.0006和p = 0.0005）相关。CT扫描异常的一些特征与治疗失败相关。药物治疗失败的病例中，低密度核心周围有边缘强化且最大长轴≥20 mm的情况更为常见（p = 0.02）。手术治疗失败与相同特征相关，但最大长轴≥30 mm（p = 0.05）。
本研究表明，儿童咽后腺炎的严重并发症罕见，CT扫描是在药物治疗和手术治疗之间进行选择的有用工具。
