Verdalle P B, Roguet E, Raynal M, Briche T, Rouquette I, Brinquin L, Jancovici R, Poncet J L
Service d'ORL et de Chirurgie Cervico-Faciale, HIA Val-de-Grâce, Paris.
Ann Otolaryngol Chir Cervicofac. 1997;114(7-8):302-9.
To outline the most appropriate treatment of descending necrotizing mediastinitis.
Three adult patients had mediastinitis occurring from a descending odontogenic infection in one case and oropharynx infection in two cases. All patients underwent extensive surgical debridement and a cervicomediastinal drainage through a cervical incision. All patients survived.
Soft-tissue infections of the neck with mediastinitis demand early diagnosis aided by CT scan in order to decrease their threat to life. Extensive surgical debridement and a cervico mediastinal drainage through a cervical incision is adequate when mediastinitis is limited to the upper mediastinum. Thoracotomy has to be performed when the process spread below the carina. Patients must be treated initially aggressively with the aid of multidisciplinary support team (intensive care physicians, thoracic and head and neck surgeons). Early surgery must treat both neck and mediastin. While usually associated with greater than 40% mortality, all the patients in this series survived.
概述降主动脉坏死性纵隔炎的最恰当治疗方法。
3例成年患者发生纵隔炎，其中1例由牙源性感染下行所致，2例由口咽感染引起。所有患者均接受了广泛的手术清创，并通过颈部切口进行颈纵隔引流。所有患者均存活。
颈部软组织感染合并纵隔炎需要借助CT扫描进行早期诊断，以降低其对生命的威胁。当中纵隔炎局限于上纵隔时，通过颈部切口进行广泛的手术清创和颈纵隔引流就足够了。当病变蔓延至隆突以下时，必须进行开胸手术。患者必须在多学科支持团队（重症监护医生、胸外科及头颈外科医生）的协助下，最初进行积极治疗。早期手术必须同时处理颈部和纵隔病变。虽然通常死亡率超过40%，但本系列所有患者均存活。
