Lustig L R, Cusick B C, Cheung S W, Lee K C
Department of Otolaryngology-Head and Neck Surgery, University of California, USA.
Otolaryngol Head Neck Surg. 1995 Jun;112(6):767-72. doi: 10.1016/S0194-59989570192-3.
Lemierre's disease consists of suppurative thrombophlebitis of the IJV in the presence of oropharyngeal infection and can be complicated by septic pulmonary emboli. If a patient has an oropharyngeal or deep neck infection and neck pain suspicious for IJV thrombosis, a CT or MRI is warranted to establish the diagnosis. Blood cultures should be obtained to establish the responsible organism. In most cases F. necrophorum, an anaerobic bacterium, is responsible for the sepsis. Once the diagnosis of Lemierre's disease is made, long-term, high-dose intravenous antibiotics with beta-lactamase anaerobic activity should be initiated. In cases with persistent sepsis and emboli despite appropriate medical management, ligation or excision of the IJV should be performed. Finally, if there is clinical or radiologic evidence of retrograde cavernous sinus thrombosis, the use of anticoagulants should be considered.
勒米尔氏病表现为在存在口咽感染的情况下颈内静脉化脓性血栓性静脉炎，并可并发脓毒性肺栓塞。如果患者有口咽或深部颈部感染且颈部疼痛怀疑为颈内静脉血栓形成，有必要进行CT或MRI检查以明确诊断。应进行血培养以确定致病微生物。在大多数情况下，坏死梭杆菌这种厌氧菌是败血症的致病菌。一旦确诊为勒米尔氏病，应开始长期、大剂量使用具有β-内酰胺酶厌氧活性的静脉抗生素治疗。对于尽管进行了适当的药物治疗仍持续存在败血症和栓子的病例，应进行颈内静脉结扎或切除。最后，如果有临床或影像学证据表明存在海绵窦逆行性血栓形成，应考虑使用抗凝剂。
