Chen Guoping, Pan Zhong, Ye Fei, Fu Minyi
Department of Otolaryngology Head and Neck Surgery，Zhongshan Hospital Affiliated to Sun Yat-sen University，Zhongshan People's Hospital，Zhongshan，528403，China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Apr;35(4):324-327. doi: 10.13201/j.issn.2096-7993.2021.04.009.
To summarize the clinical manifestations and treatment of patients with deep neck infection with descending mediastinal infection. The clinical data of 12 patients with deep neck infection with descending mediastinal infection were reviewed. The clinical manifestations, infection origin, bacterial culture results, related systemic diseases, surgical drainage methods and treatment results were analyzed. The typical clinical features of descending mediastinal infection were chest pain and subcutaneous crackling, diagnosis can confirmed by CT scan detected gas and abscess in the neck and mediastinal space. The main origin of infection was pharyngeal infection, followed by odontogenic infection. Systemic diseases were mainly diabetes mellitus. The positive rate of purulent secretion culture was 58.3%（7/12）, streptococcus account for the highest proportion. Surgical treatment included 9 patients undergoing neck surgery alone and 3 patients undergoing combined neck and chest surgery. Chest drainage was performed by thoracic surgery through mediastinoscopy or thoracoscopic surgery or B-ultrasound guided puncture, and no patient underwent open surgery. Ten patients were cured and two died, with a mortality rate of 16.7%. The deep neck infection with descending mediastinal infection has no specificity in the early stage. Timely abscess drainage, effective airway protection, antimicrobial therapy, and management of potentially life-threatening complications such as sepsis, mediastinitis, and pneumonia are the key to successful treatment.
总结伴有纵隔感染的颈部深部感染患者的临床表现及治疗情况。回顾性分析12例伴有纵隔感染的颈部深部感染患者的临床资料，对其临床表现、感染来源、细菌培养结果、相关全身性疾病、手术引流方式及治疗效果进行分析。纵隔感染的典型临床特征为胸痛及皮下捻发音，颈部及纵隔间隙内气体及脓肿通过CT扫描得以确诊。感染主要来源为咽部感染，其次为牙源性感染。全身性疾病主要为糖尿病。脓性分泌物培养阳性率为58.3%（7/12），链球菌所占比例最高。手术治疗方面，9例患者仅接受颈部手术，3例患者接受颈部及胸部联合手术。胸部引流由胸外科通过纵隔镜、胸腔镜手术或B超引导下穿刺进行，无患者接受开胸手术。10例患者治愈，2例死亡，死亡率为16.7%。伴有纵隔感染的颈部深部感染早期无特异性表现。及时进行脓肿引流、有效保护气道、抗菌治疗以及处理如脓毒症、纵隔炎和肺炎等潜在危及生命的并发症是治疗成功的关键。
