Marty-Ane C H, Alauzen M, Alric P, Serres-Cousine O, Mary H
Service de Chirurgie Thoracique et Vasculaire, Hôpital Arnaud de Villeneuve, Montpellier, France.
J Thorac Cardiovasc Surg. 1994 Jan;107(1):55-61.
Descending necrotizing mediastinitis can occur as a complication of oropharyngeal and cervical infections that spread to the mediastinum via the cervical spaces. Delayed diagnosis and inadequate mediastinal drainage through a cervical or minor thoracic approach are the primary causes of a high published mortality rate (near 40%). Between 1985 and 1992, six men (mean age, 49 years) with descending necrotizing mediastinitis were surgically treated at our institution. The primary oropharyngeal infection was peritonsillar abscess (three cases) and odontogenic abscess (three cases). In all cases, occurrence of respiratory insufficiency associated with serious cervical infection suggested the mediastinitis diagnosis. Computed tomographic scans confirmed the mediastinitis, showing mediastinal abscess and mediastinal emphysema. All patients underwent surgical drainage of the deep neck infection combined with mediastinal drainage through a thoracic approach. The outcome was favorable in five patients who had mediastinal drainage through a thoracotomy; the patient who had mediastinal drainage through a minor thoracic approach (anterior mediastinotomy) died of tracheal fistula on postoperative day 18. In our experience, aggressive mediastinal drainage by a thoracotomy approach regardless of the level of mediastinal involvement led to improvement in survival of these patients, with a 17% mortality rate.
下行性坏死性纵隔炎可作为口咽和颈部感染的并发症出现，这些感染通过颈部间隙蔓延至纵隔。延迟诊断以及通过颈部或小切口开胸手术进行的纵隔引流不充分是已公布的高死亡率（接近40%）的主要原因。1985年至1992年间，我院对6例下行性坏死性纵隔炎患者进行了外科治疗。这些患者均为男性，平均年龄49岁。原发性口咽感染为扁桃体周围脓肿（3例）和牙源性脓肿（3例）。在所有病例中，与严重颈部感染相关的呼吸功能不全提示纵隔炎的诊断。计算机断层扫描证实了纵隔炎，显示纵隔脓肿和纵隔气肿。所有患者均接受了颈部深部感染的手术引流，并通过开胸手术进行纵隔引流。5例通过开胸手术进行纵隔引流的患者预后良好；1例通过小切口开胸手术（前纵隔切开术）进行纵隔引流的患者在术后第18天死于气管瘘。根据我们的经验，无论纵隔受累程度如何，通过开胸手术积极进行纵隔引流可提高这些患者的生存率，死亡率为17%。
