牙源性颈深部多间隙及纵隔脓肿2例并文献复习
Two cases of odontogenic deep cervical multi-space and mediastinal abscess and literature review
宋攀攀 1赵玉凤 1张瑶瑶 1丁德涛 1张加夫 1张辉 1张瑾 2吴允刚1
作者信息
- 1. 济宁医学院附属医院 耳鼻咽喉头颈外科,山东 济宁 272029
- 2. 济宁医学院 临床医学院,山东 济宁 272067
- 折叠
摘要
目的 回顾性分析与总结颈深部多间隙脓肿、纵隔脓肿及脓胸的临床诊治经验,以提高临床医生对本病的认识与诊疗水平.方法 对牙源性颈深部多间隙及纵隔脓肿患者的临床特点、相关检查、治疗及随访情况进行回顾性分析及文献回顾.结果 对 2 例患者的脓液进行细菌学培养,例 1 患者胸腔穿刺引流脓液培养出肺炎克雷伯菌,于全麻下行咽后脓肿引流术+胸腔镜下纵膈脓肿切开引流术+经胸腔镜脓胸清除术(双侧)+气管切开术,住院时间共 65 d;例 2 患者脓液细菌药敏检验提示中间链球菌感染,于全麻下行经口脓肿切开引流+胸腔镜下前纵膈脓肿切开引流术+气管切开术,住院 37 d.结论 重症颈深部多间隙及纵膈脓肿临床上少见,且因其发展迅速,致死率较高,值得引起临床医生重视.脓肿切开引流和联合应用敏感抗生素是本病的主要治疗方法,气管切开是保障术后安全的必要条件,对于减少并发症及改善预后也起到了重要作用.早期诊断、合理应用敏感抗生素和及时切开引流、多学科的协作等是诊治的关键.
Abstract
Objective The objective of this study was to retrospectively analyze and summarize the clinical diagnosis and treatment experiences of patients with deep cervical multi-space abscess,mediastinal abscess,and empyema in order to improve the under-standing and treatment levels of clinicians.Methods The clinical characteristics,related examination,treatment,and follow-up of two patients with odontogenic deep cervical multiple space and mediastinal abscess were retrospectively analyzed.A literature review was also conducted.Results Bacterial culture was performed on the pus of each patient.Klebsiella pneumoniae was cultured from the pus of Case 1.The patient was hospitalized for 65 days after retropharyngeal abscess drainage plus thoracoscopic mediastinal abscess incision,as well as drainage plus thoracoscopic empyema removal(bilateral)plustracheotomy under general anesthesia.In Case 2,the bacterial sensitivity test of the pus indicated intermediate streptococcal infection.Incision and drainage of oral abscess plus thoracoscopic incision and drainage of anterior mediastinal abscess plustracheotomy were performed under general anesthesia.The patient was hospitalized for 37 days.Conclusion Severe deep cervical multi-space and mediastinal abscess is rare in clinic,and its rapid development and high fatality rate deserves attention.Abscess incision and drainage and combined application of sensitive antibiotics are the main treatment methods.Tracheotomy is a necessary procedure to ensure postoperative safety,and also plays an important role in reducing complications and improving prognosis.Early diagnosis,rational application of sensitive antibiotics,timely incision and drainage,and multidisciplinary cooperation are the keys to diagnosis and treatment.
关键词
颈深部间隙脓肿/纵隔脓肿/气管切开/牙源性感染Key words
Deep cervical interstitial abscess/Mediastinal abscess/Tracheotomy/Odontogenic infection引用本文复制引用
基金项目
济宁市科技计划重点研发计划(2021YXNS028)
济宁市科技计划重点研发计划(2021YXNS048)
济宁市科技计划重点研发计划(2021YXNS052)
贺林院士新医学临床转化工作站科研基金(JYHL2022FMS11)
济宁医学院附属医院主诊医师团队专项研究计划(ZZTD-2022-007)
出版年
2024
NETL
NSTL
万方数据