Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
Eur Arch Otorhinolaryngol. 2013 Mar;270(4):1463-6. doi: 10.1007/s00405-012-2182-5. Epub 2012 Sep 18.
This study aims to identify predisposing characteristics of descending necrotizing mediastinitis (DNM) arising from deep neck infection (DNI) and to determine appropriate therapeutic intervention strategies. We retrospectively reviewed 54 patients (male, n = 34; female, n = 20; mean age, 64.5 years) who had been treated at Mie University Hospital for DNI between April 2001 and October 2011. Eight of nine patients who developed DNM confirmed by computed tomography of the neck and chest, underwent mediastinal drainage (video-assisted thoracic surgical drainage, n = 6; mediastinoscopy-assisted drainage, n = 2). A patient developed uncontrolled acute respiratory distress syndrome after aggressive surgery, resulting in a mortality rate of 12 %. High blood CRP values, and the pharynx and tonsils as origins of infection were factors involved in the development of DNM arising from DNI. In conclusion, DNM remains a destructive and fatal disease that requires aggressive treatment including mediastinal exploration.
本研究旨在确定源于深部颈感染（DNI）的下行坏死性纵隔炎（DNM）的易患特征，并确定适当的治疗干预策略。我们回顾性分析了 2001 年 4 月至 2011 年 10 月在日本三重大学医院接受 DNI 治疗的 54 名患者（男性，n = 34；女性，n = 20；平均年龄，64.5 岁）。9 例经颈部和胸部 CT 证实患有 DNM 的患者中，有 8 例接受了纵隔引流（视频辅助胸腔外科引流，n = 6；纵隔镜辅助引流，n = 2）。1 例患者在积极手术后发生了无法控制的急性呼吸窘迫综合征，死亡率为 12%。高血 CRP 值和咽扁桃体作为感染起源是导致 DNI 引发 DNM 的因素。总之，DNM 仍然是一种具有破坏性和致命性的疾病，需要包括纵隔探查在内的积极治疗。
