Dzian Anton, Malík Marek, Fučela Ivan, Skaličanová Michaela, Stiegler Peter, Hajtman Andrej, Bugová Gabriela, Sániová Beata Drobná
Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital in Martin, Slovakia.
Department of Otorhinolaryngology and Head and Neck Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital in Martin, Slovakia.
Neuro Endocrinol Lett. 2019 Dec;40(6):284-288.
Descending necrotizing mediastinitis (DNM) is a severe potentially fatal disease of the mediastinum which spreads downwards from oropharyngeal region. Mortality varies from 11 to 40%. There is agreement on the importance of early diagnosis, aggressive surgical treatment and the need for a multidisciplinary approach.
Retrospective study of series of patient treated for DNM regarding multidisciplinary approach and surgical treatment.
Sixteen patients that were surgically treated for DNM from 2008 to 2017 at our hospital were consecutively enrolled in observational descriptive study.
Twelve patients had disease localised above tracheal bifurcation level. Nine of them underwent transcervical drainage, three patients underwent more extensive treatment. Four patients with disease spread below the treacheal bifurcation level were treated with transcervical drainage in combination with posterolateral thoracotomy or videothoracoscopy. Three patients underwent videothoracoscopy - two of them as primary surgical treatment with need of one reoperation - contralateral videothoracoscopy. The third patient was initially treated with a transcervical approach and videothoracoscopy was indicated as a reoperation because of the progression of the disease. One patient died (mortality 6.25%).
In management of descending necrotizing mediastinitis, early diagnosis, aggressive surgical treatment and use of broad-spectrum antibiotics and nowadays also multidisciplinary approach are crucial. Transcervical drainage combined with posterolateral thoracotomy or videothoracoscopy were used with good results.
下行性坏死性纵隔炎（DNM）是一种严重的、可能致命的纵隔疾病，它从口咽区域向下蔓延。死亡率在11%至40%之间。对于早期诊断、积极的手术治疗以及多学科方法的必要性已达成共识。
关于多学科方法和手术治疗的DNM系列患者的回顾性研究。
2008年至2017年在我院接受手术治疗的16例DNM患者连续纳入观察性描述性研究。
12例患者的疾病局限于气管分叉水平以上。其中9例接受了经颈引流，3例患者接受了更广泛的治疗。4例疾病蔓延至气管分叉水平以下的患者接受了经颈引流联合后外侧开胸术或电视胸腔镜检查。3例患者接受了电视胸腔镜检查——其中2例作为初次手术治疗，需要再次手术——对侧电视胸腔镜检查。第3例患者最初采用经颈入路治疗，由于疾病进展，电视胸腔镜检查被用作再次手术。1例患者死亡（死亡率6.25%）。
在下行性坏死性纵隔炎的治疗中，早期诊断、积极的手术治疗、使用广谱抗生素以及如今的多学科方法至关重要。经颈引流联合后外侧开胸术或电视胸腔镜检查应用效果良好。
