Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.
Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China.
Acta Otolaryngol. 2023 May-Jun;143(6):514-517. doi: 10.1080/00016489.2023.2220369. Epub 2023 Jul 2.
Pneumatosis in the cervical fascial space is a common imaging manifestation of cervical necrotizing fasciitis. At present, although there are some literature reports on pneumatosis in the cervical necrotizing fasciitis, there are few comparative reports.
To compare the imaging findings of necrotizing fasciitis of the neck and other cervical space infections, and explore the relationship between pneumatosis in cervical fascial space and necrotizing fasciitis of the neck.
A retrospective study was conducted on 56 cases of cervical fascia space infection in our department from May 2015 to March 2021, including 22 cases of necrotizing fasciitis and 34 cases of non-necrotizing fasciitis. 22 cases underwent incision, debridement and catheter drainage in the necrotizing fasciitis group. 26 cases underwent incision, debridement and catheter drainage, and 8 cases underwent ultrasound-guided puncture biopsy and catheter drainage in the non-necrotizing fasciitis group. All cases were confirmed by operation or pathological biopsy and took purulent secretions for bacterial culture and drug sensitivity test during or after operation. All cases were examined by neck CT or MRI before operation. The previous history of surgical incision or puncture and the rupture of cervical space infection were excluded.
In 22 cases of necrotizing fasciitis, there were 19 cases had air accumulation in the fascial space (86.4%); In 34 cases of non necrotizing fasciitis, 2 cases had air accumulation in the fascial space (5.9%). There was significant difference between the two groups (χ = 36.9141, < .01). Bacterial culture results were positive in 18 (81.8%) patients in the necrotizing fasciitis group. In the non necrotizing fasciitis group, 12 (35.3%) patients had positive bacterial culture results. There was significant difference in the positive rate of bacterial culture between the two groups (χ = 11.6239, < .01). Except one death in necrotizing fasciitis group, all other patients were cured. There was no recurrence after follow-up for 3-6 months.
The pneumatosis of necrotizing fasciitis in the neck is dramatically more than that of other infectious diseases. It is suggested that pneumatosis in cervical fascial space is of great significance in the diagnosis of cervical necrosis, the gas production of bacteria may be closely related to the pathogenesis and development of necrotizing fasciitis of the neck, and early measures to block the generation and dissemination of gas is of great significance for treatment.
颈筋膜间隙积气是颈坏死性筋膜炎的常见影像学表现。目前，虽然有一些关于颈坏死性筋膜炎积气的文献报道，但比较性报道较少。
比较颈坏死性筋膜炎与其他颈间隙感染的影像学表现，探讨颈筋膜间隙积气与颈坏死性筋膜炎的关系。
回顾性分析 2015 年 5 月至 2021 年 3 月我院收治的 56 例颈筋膜间隙感染患者的临床资料，其中颈坏死性筋膜炎 22 例，非颈坏死性筋膜炎 34 例。坏死性筋膜炎组 22 例行切开、清创及导管引流，非坏死性筋膜炎组 26 例行切开、清创及导管引流，8 例行超声引导下穿刺活检及导管引流。所有病例均经手术或病理活检证实，并于术中或术后取脓性分泌物进行细菌培养和药敏试验。所有病例术前均行颈 CT 或 MRI 检查，排除既往有手术切口或穿刺史及颈间隙感染破裂者。
22 例颈坏死性筋膜炎中，筋膜间隙积气 19 例（86.4%）；34 例非颈坏死性筋膜炎中，筋膜间隙积气 2 例（5.9%）。两组比较差异有统计学意义（χ=36.9141， < .01）。坏死性筋膜炎组细菌培养阳性 18 例（81.8%），非坏死性筋膜炎组细菌培养阳性 12 例（35.3%）。两组细菌培养阳性率比较差异有统计学意义（χ=11.6239， < .01）。除 1 例坏死性筋膜炎组死亡外，其余患者均治愈，随访 3~6 个月无复发。
颈坏死性筋膜炎的筋膜间隙积气量明显多于其他感染性疾病。提示颈筋膜间隙积气对颈坏死的诊断具有重要意义，产气细菌可能与颈坏死性筋膜炎的发病机制和发展密切相关，早期采取措施阻断气体的产生和传播对治疗具有重要意义。
