早期手术干预可促进严重小儿深部颈感染患者的康复。
Early surgical intervention enhances recovery of severe pediatric deep neck infection patients.
机构信息
Department of Otorhinolaryngology and Head and Neck Surgery, Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520, Turku, Finland.
Department of Oral and Maxillofacial Surgery, Turku University Hospital and University of Turku, Lemminkäisenkatu 2, 20520, Turku, Finland.
出版信息
Int J Pediatr Otorhinolaryngol. 2021 May;144:110694. doi: 10.1016/j.ijporl.2021.110694. Epub 2021 Mar 28.
PURPOSE
Pediatric deep neck space infection (DNI) is a relatively rare but potentially life-threatening condition and requires prompt and accurate management. This study retrospectively reviews our experience in a tertiary referral hospital from 2004 to 2019.
METHODS
Systematic data collection from medical records using ICD10 codes between 2004 and 2019.
INCLUSION CRITERIA
age ≤16 years, DNI requiring hospitalization and/or surgery. EXCLUSION: peritonsillar abscess without complications.
RESULTS
We identified 42 patients, 21 boys and 21 girls, with a median age of 4.9 years. Most of the patients had severe symptoms, the most common of which were neck swelling (n = 39; 92.9%), neck pain (n = 39; 92.9%) and fever (n = 32; 76.2%). Twenty-two (52.4%) had torticollis, and the mean duration of symptoms before hospitalization was 4.95 days. Diagnosis was confirmed by MRI (n = 24), contrast-enhanced CT (n = 11) or ultrasonography (n = 6), except in one case. Twenty-three (54.8%) required an open neck incision, ten (23.8%) patients had intraoral surgery and nine were treated conservatively. Twelve (28.6%) patients were admitted to the pediatric ICU. Median hospitalization duration was six days. The infection most commonly had tonsillopharyngeal etiology (n = 18) and a retropharyngeal location (n = 17). Staphylococcus Aureus (n = 7) and Streptococcus pyogenes (n = 7) were the most frequent pathogens. We compared the early surgical intervention group (<2 days of intravenous antibiotics; n = 18; 42.9%) to the late surgery group (n = 15; 35.7%) and the conservatively treated groups (n = 9; 21.4%). The overall length of stay (LOS) was lower in the shorter preoperative medication group (mean 4.4 vs. 7.2; p = 0.009). The size of the abscess did not differ between the groups (mean 28 mm; 30 mm; 21 mm; p = 0.075) and the neck incision rate was similar in the operated groups.
CONCLUSION
Early surgical intervention is associated with decreased LOS among severe pediatric DNI patients.
目的
小儿深部颈部间隙感染（DNI）是一种相对罕见但潜在危及生命的疾病，需要及时准确的治疗。本研究回顾性分析了我们 2004 年至 2019 年在一家三级转诊医院的经验。
方法
使用 2004 年至 2019 年的 ICD10 代码从病历中系统地收集数据。
纳入标准
年龄≤16 岁，需要住院和/或手术治疗的 DNI。排除标准：无并发症的扁桃体周围脓肿。
结果
我们共纳入了 42 名患者，其中男 21 例，女 21 例，中位年龄为 4.9 岁。大多数患者症状严重，最常见的症状为颈部肿胀（n=39；92.9%）、颈部疼痛（n=39；92.9%）和发热（n=32；76.2%）。22 例（52.4%）有斜颈，住院前症状平均持续时间为 4.95 天。24 例患者通过 MRI 确诊，11 例患者通过增强 CT 确诊，6 例患者通过超声确诊，仅 1 例患者除外。23 例（54.8%）需行颈部开放切口，10 例（23.8%）患者行口腔内手术，9 例患者接受保守治疗。12 例（28.6%）患者入住儿科重症监护病房。中位住院时间为 6 天。感染最常见的病因是咽扁桃体（n=18），部位为咽后（n=17）。金黄色葡萄球菌（n=7）和化脓性链球菌（n=7）是最常见的病原体。我们比较了早期手术干预组（<2 天静脉用抗生素；n=18；42.9%）和晚期手术组（n=15；35.7%）以及保守治疗组（n=9；21.4%）。术前用药时间较短的患者总体住院时间（LOS）较短（平均 4.4 天 vs. 7.2 天；p=0.009）。各组脓肿大小无差异（平均 28mm；30mm；21mm；p=0.075），手术组的颈部切口率相似。
结论
严重小儿 DNI 患者早期手术干预与 LOS 缩短有关。
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