Iriyama T, Sugimura S, Hattori Y, Senga M, Takeda I, Kanou H, Ozawa K, Matsuyama T
Department of Thoracic Surgery, Fujita Health University School of Medicine, Aichi, Japan.
Kyobu Geka. 1997 Jan;50(1):78-81.
A 41-year-old man was admitted to a hospital elsewhere because of tonsillitis with high grade fever. On the 9th day of hospitalization, the patient complained of dysphagia and dyspnea. A chest X-ray film and a CT scan showed right pleural effusion and pericardial effusion, and he was referred to our hospital. Immediately after admission, he underwent pericardiotomy to relieve cardiac tamponade, and a right thoracic tube was inserted for pyothorax. Next day, mediastinal drainage was accomplished through a cervical incision and a right thoracotomy. Eight drainage tubes were left in place. Cultures revealed alpha-Streptococcus, Neisseria and group F Streptococci. Continuous closed irrigation with diluted Isodine (povidone iodine) solution was performed. The last extubation of the drainage tube was done on the 140th day after operation. He was cured and discharged on the 162nd day after operation. In patients with extensive acute mediastinitis secondary to deep cervical infection, early complete mediastinal drainage via a cervical and a transthoracic incision is essential.
一名41岁男性因扁桃体炎伴高热入住外地一家医院。住院第9天，患者出现吞咽困难和呼吸困难。胸部X线片和CT扫描显示右侧胸腔积液和心包积液，遂转诊至我院。入院后立即行心包切开术以缓解心脏压塞，并插入右侧胸腔引流管治疗脓胸。次日，通过颈部切口和右侧开胸进行纵隔引流。留置了8根引流管。培养结果显示为甲型链球菌、奈瑟菌和F组链球菌。用稀释的碘伏溶液进行持续闭式冲洗。术后第140天最后拔除引流管。患者术后第162天治愈出院。对于继发于深部颈部感染的广泛急性纵隔炎患者，早期通过颈部和经胸切口进行彻底纵隔引流至关重要。
