Mikami K, Izumi H, Masuda S, Yamamoto S, Hosoda Y
Department of Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Aug;45(8):1096-101.
A 69-year-old man complained of a sore throat, neck swelling, and disturbance of swallowing with dyspnea. He underwent tracheostomy and cervical drainage. The plain chest roentgenogram and CT scans suggested mediastinitis, so he was transferred to our hospital. Cultures revealed a mixed aerobic and anaerobic infection. On hospital day 2, the neck was explored and pus was found in the connective tissue. Despite drainage and intravenous panipenem with betamipron and clindamycin, he remained febrile and a mediastinal abscess was seen on repeat CT. On hospital day 10, reexploration of the mediastinum was done through cervical and right thoracotomy incisions. A large amount of pus was drained from the posterior mediastinum and its necrotic tissue was debrided. Myocardial infarction occurred intraoperatively, but the patient was successfully resuscitated. Following this procedure, the patient's condition and radiologic findings gradually improved. Cultures of the drain fluid became negative, and he was discharged on hospital day 103. In conclusion, both transcervical drainage and aggressive mediastinal exploration via thoracotomy are essential to salvage a patient with descending necrotizing mediastinitis. CT scanning is useful for early diagnosis of mediastinitis and for follow up.
一名69岁男性主诉咽痛、颈部肿胀、吞咽困难伴呼吸困难。他接受了气管切开术和颈部引流。胸部X线平片和CT扫描提示纵隔炎，因此他被转至我院。培养结果显示为需氧菌和厌氧菌混合感染。住院第2天，对颈部进行探查，在结缔组织中发现脓液。尽管进行了引流，并静脉使用帕尼培南-倍他米隆和克林霉素治疗，但他仍持续发热，复查CT显示有纵隔脓肿。住院第10天，通过颈部和右胸切口再次探查纵隔。从后纵隔引出大量脓液，并清除其坏死组织。术中发生心肌梗死，但患者成功复苏。经过该手术后，患者的病情和影像学表现逐渐改善。引流液培养结果转为阴性，他于住院第103天出院。总之，经颈部引流和通过开胸进行积极的纵隔探查对于挽救下行性坏死性纵隔炎患者至关重要。CT扫描有助于纵隔炎的早期诊断和随访。
