Academic Clinic of Otolaryngology and Head-Neck Surgery, Department of Surgical Sciences, University of Florence, Florence, Italy.
Laryngoscope. 2012 Apr;122(4):785-8. doi: 10.1002/lary.22403. Epub 2012 Jan 17.
A 57-year-old immunocompetent male patient with a deep neck abscess involving the mediastinum was referred to us following unsuccessful treatment at his local hospital with medical therapy and ultrasound-guided aspiration. After initial evaluation and resuscitation, a contrast-enhanced computed tomography (CT) scan was performed, and the patient was transferred for surgical drainage. A vacuum-assisted closure (VAC) device was used as a surgical drain to help prevent reaccumulation of the purulent collections. A repeat CT scan on day 3 confirmed the absence of residual pus in the mediastinum and in the neck spaces, and the VAC device was removed. Perfect healing of the deep tissues with successful mediastinal toilette was observed. The patient resumed oral meals on postoperative day 10, and 2 days later he was discharged. A 1-month follow-up CT again demonstrated the complete healing and absence of the neck abscess. This case illustrates the possibility of avoiding more extensive and life-threatening procedures, such as open thoracotomy, in the treatment of neck abscesses extending into the mediastinum, and highlights the utility of VAC in the management of deep neck abscesses.
一位 57 岁免疫功能正常的男性患者，因深部颈部脓肿累及纵隔，在当地医院接受药物治疗和超声引导下抽吸治疗后效果不佳，随后转至我院。在初步评估和复苏后，进行了增强对比度计算机断层扫描（CT）检查，并将患者转科进行手术引流。使用真空辅助闭合（VAC）装置作为手术引流管，以帮助防止脓性积聚物再次积聚。第 3 天的重复 CT 扫描证实纵隔和颈部间隙内无残留脓液，随后移除了 VAC 装置。深部组织愈合良好，纵隔清理成功。患者于术后第 10 天开始恢复口服饮食，两天后出院。1 个月后的 CT 随访再次显示颈部脓肿完全愈合。该病例说明了在治疗延伸至纵隔的颈部脓肿时，避免更广泛和危及生命的手术（如开胸手术）的可能性，并强调了 VAC 在深部颈部脓肿管理中的应用价值。
