Prado-Calleros Héctor M, Jiménez-Fuentes Edgardo, Jiménez-Escobar Irma
Division of Otolaryngology and Head and Neck Surgery, General Hospital "Dr. Manuel Gea González,", México City, México.
Department of Thorax Surgery, National Institute of Cancer, México.
Head Neck. 2016 Apr;38 Suppl 1:E2275-83. doi: 10.1002/hed.24183. Epub 2016 Feb 1.
Descending necrotizing mediastinitis is a serious infection involving the neck and the chest, in which an odontogenic, pharyngeal, or cervical infection spreads rapidly to the thoracic cavity, with a high death rate by sepsis and organic failure if not treated quickly and properly.
A systematic search in the electronic database PubMed was conducted using the keywords "mediastinitis" and "descending necrotizing mediastinitis" resulting in 2560 items, filters were activated (systematic review, meta-analysis, and clinical trial) resulting in 60 articles, from which we selected relevant articles on the topic.
The best available evidence we could obtain was from 26 case series with evidence level III. The overall mortality in this period was 17.5%.
For mediastinitis limited to the upper part of the mediastinum, transcervical drainage may be sufficient; cases that extended below the tracheal carina may require cervical and transthoracic drainage. A multidisciplinary therapeutic approach has allowed a reduction in its mortality. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2275-E2283, 2016.
下行性坏死性纵隔炎是一种累及颈部和胸部的严重感染，其中牙源性、咽部或颈部感染迅速蔓延至胸腔，若不迅速且恰当地治疗，因脓毒症和器官功能衰竭导致的死亡率很高。
在电子数据库PubMed中使用关键词“纵隔炎”和“下行性坏死性纵隔炎”进行系统检索，共得到2560条记录，激活筛选条件（系统评价、荟萃分析和临床试验）后得到60篇文章，从中选取该主题的相关文章。
我们能获得的最佳现有证据来自26个病例系列，证据等级为III级。在此期间的总体死亡率为17.5%。
对于局限于纵隔上部的纵隔炎，经颈引流可能就足够了；延伸至气管隆突以下的病例可能需要颈胸联合引流。多学科治疗方法已使死亡率有所降低。© 2016威利期刊公司。《头颈》38: E2275 - E2283, 2016。
