Safranek Jarmil, Skala Martin, Vejvodova Sarka, Hosek Petr
Chirurgische Klinik, Universitätskrankenhaus Pilsen, Tschechische Republik.
Chirurgische Klinik, Medizinische Fakultät der Karlsuniversität und Universitätskrankenhaus Pilsen, Tschechische Republik.
Zentralbl Chir. 2021 Aug;146(S 01):S19-S25. doi: 10.1055/a-1346-0210. Epub 2021 Feb 3.
Descending necrotising mediastinitis (DNM) is a rare, but very severe, septic condition, caused by the spread of infection from the neck to the mediastinum. Delay in diagnosis and inadequate surgical procedures may lead to a life-threatening situation.
We retrospectively evaluated a group of patients who suffered from DNM and were treated in our department by mediastinal drainage in the last 10 years (2010 - 2019). All patients required one of the following methods of drainage: cervicomediastinal, mediastinothoracic or cervicomediastinothoracic "Rendevouz" drainage (MTC-D). In the group, we evaluated the source of infection, microbiologic findings, method of mediastinal drainage, length of hospitalisation, ventilation duration and inflammatory laboratory parameters.
In total, we treated 22 patients with DNM, including 14 men and 8 women, aged 23 - 85 years, with a mean age of 54.1 years. After the spread of infection, in 8 cases the initial cervicomediastinal type of drainage had to be followed by one of the types of thoracic drainage. As the final method, in 8 patients we chose irrigation drainage from the cervical approach, from thoracotomy in 6 cases and in 8 cases irrigation CMT-D. The method of mediastinal drainage was chosen according to the initial CT findings, and further intervention was chosen according to CT signs during the treatment. Four patients died of DNM (mortality 18.2%). Pharyngeal focus was responsible for 15 cases of DNM; odontogenic infection caused 6 DNM cases; in 1 case the origin was unclear. Although we always chose the method individually and CMT-D for the most difficult cases, there were no statistically significant (p < 0.05) differences between the evaluated parameters. For CMT-D, there was even a shorter hospital stay (not significant) and ventilation duration.
In cases of DNM with severe inflammation of caudal and distal compartments of the mediastinum we consider CMT-D as an ideal method of treatment. This appraoch is radical enough and in our group of patients, despite the severity of this illness, both the length of treatment and mortality were sufficient.
下行性坏死性纵隔炎（DNM）是一种罕见但极为严重的感染性疾病，由颈部感染蔓延至纵隔所致。诊断延误和手术操作不当可能导致危及生命的情况。
我们回顾性评估了过去10年（2010 - 2019年）在我院接受纵隔引流治疗的一组DNM患者。所有患者均需采用以下引流方法之一：颈纵隔、纵隔胸或颈纵隔胸“会师”引流（MTC - D）。在该组患者中，我们评估了感染源、微生物学检查结果、纵隔引流方法、住院时间、通气时间和炎症实验室指标。
我们共治疗了22例DNM患者，其中男性14例，女性8例，年龄23 - 85岁，平均年龄54.1岁。感染扩散后，8例患者最初采用颈纵隔引流，随后需采用一种胸段引流方法。最终，8例患者选择经颈部途径冲洗引流，6例患者选择开胸手术，8例患者选择CMT - D冲洗引流。纵隔引流方法根据最初的CT检查结果选择，治疗期间根据CT征象选择进一步的干预措施。4例患者死于DNM（死亡率18.2%）。咽部感染灶导致15例DNM；牙源性感染导致6例DNM；1例感染源不明。尽管我们总是根据个体情况选择方法，对于最困难的病例选择CMT - D，但评估参数之间无统计学显著差异（p < 0.05）。对于CMT - D，住院时间甚至更短（无统计学意义），通气时间也更短。
对于纵隔尾部和远端严重炎症的DNM病例，我们认为CMT - D是理想的治疗方法。这种方法足够彻底，在我们的患者组中，尽管疾病严重，但治疗时间和死亡率均令人满意。
