Guan Xin, Liang Xiang, Liang Xi, Wang Feng, Qian Wentao, Zhang Weijie
Department of Thoracic Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Clinical Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ann Transl Med. 2021 Feb;9(4):356. doi: 10.21037/atm-21-121.
Descending necrotizing mediastinitis (DNM) is an inflammation occurring in the oropharynx and descending to the deep cervical space and mediastinum, which is a serious infectious disease. The investigation of a new classification system and treatment methods for DNM is still necessary.
A total of 139 patients with DNM caused by odontogenic or pharyngeal infection were retrospectively analyzed in last 20 years in the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The patients were divided into the traditional treatment Group T (Group T: 43 patients) and the new classification Group N (Group N: 96 patients). A new DNM classification was developed based on the progression of mediastinal infection as follows: type Ia: infection in the anterosuperior mediastinum; type I: infection in the anterior mediastinum; type II: infection in the posterior mediastinum; and type III: infection of the whole mediastinum.
There were 49, 8, 10, and 29 patients classified as type Ia, I, II, and III, respectively in the Group N. The type Ia DNM patients were managed with transcervical mediastinal drainage, and the patients with types I and II DNM underwent open (thoracoscopic) surgery, 1 patient within types I died. The 29 patients with type III were managed with unilateral or bilateral open (thoracoscopic) surgery, among them, 8 patients died. The mortality rate for patients with type III DNM was 27.6%. The overall mortality rate in Group N was 9.4%. The mortality rate for patients in the Group T was 25.6%. The mortality rate of Group N was significantly lower than that of Group T (P<0.05).
We have carried out a new clinical classification of DNM, and selected the appropriate treatment method according to the classification, and achieved a better effect than the traditional treatment method.
下行性坏死性纵隔炎（DNM）是一种发生于口咽并向下蔓延至颈深部间隙及纵隔的炎症，是一种严重的感染性疾病。对DNM新的分类系统及治疗方法的研究仍很有必要。
回顾性分析上海交通大学医学院附属第九人民医院过去20年中139例由牙源性或咽部感染引起的DNM患者。将患者分为传统治疗组T（T组：43例患者）和新分类组N（N组：96例患者）。基于纵隔感染的进展制定了一种新的DNM分类如下：Ia型：前上纵隔感染；I型：前纵隔感染；II型：后纵隔感染；III型：全纵隔感染。
N组中分别有49、8、10和29例患者被分类为Ia型、I型、II型和III型。Ia型DNM患者采用经颈纵隔引流治疗，I型和II型DNM患者接受开放（胸腔镜）手术，I型中有1例患者死亡。29例III型患者采用单侧或双侧开放（胸腔镜）手术治疗，其中8例患者死亡。III型DNM患者的死亡率为27.6%。N组的总死亡率为9.4%。T组患者的死亡率为25.6%。N组的死亡率显著低于T组（P<0.05）。
我们对DNM进行了新的临床分类，并根据分类选择了合适的治疗方法，取得了比传统治疗方法更好的效果。
