Wei Dong, Bi Ling, Zhu Huiyong, He Jianfeng, Wang Huiming
Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Medicine (Baltimore). 2017 Apr;96(15):e6590. doi: 10.1097/MD.0000000000006590.
By a 7-year retrospective review, we reported our experience in management of descending necrotizing mediastinitis (DNM) and deep neck infection (DNI). A retrospective design was used to reveal the clinical characteristics of DNI and DNM. The clinical outcome was analyzed to validate less invasive management. We reviewed 82 patients between 2009 and 2016, 12 of which were diagnosed as DNM by clinical and computed tomography findings. A total of 35 patients had relevant systemic conditions, mainly diabetes mellitus (19 patients). Most cases were secondary to oropharyngeal or dental infections. All patients underwent transcervical drainage, and 10 DNM patients were treated with additional closed thoracic drainage simultaneously. Twenty patients accepted more than 1 operation. Seven patients died as a result of sepsis and/or multiple organ failure. The mortality rate in our study was similar to that in other studies. In our opinion, less invasive therapies are useful to most patients. Transcervical drainage alone is optimal management for all DNI cases and some DNM cases. Additional closed thoracic drainage is enough for type I and IIA DNM with pleural effusion or empyema.
通过一项为期7年的回顾性研究，我们报告了我们在降主动脉坏死性纵隔炎（DNM）和深部颈部感染（DNI）管理方面的经验。采用回顾性设计来揭示DNI和DNM的临床特征。分析临床结果以验证微创管理的有效性。我们回顾了2009年至2016年间的82例患者，其中12例根据临床和计算机断层扫描结果诊断为DNM。共有35例患者患有相关的全身疾病，主要是糖尿病（19例）。大多数病例继发于口咽或牙科感染。所有患者均接受了经颈引流，10例DNM患者同时接受了额外的闭式胸腔引流。20例患者接受了不止一次手术。7例患者因败血症和/或多器官衰竭死亡。我们研究中的死亡率与其他研究相似。我们认为，微创治疗对大多数患者有用。单纯经颈引流是所有DNI病例和一些DNM病例的最佳治疗方法。对于伴有胸腔积液或脓胸的I型和IIA型DNM，额外的闭式胸腔引流就足够了。
