山东大学耳鼻喉眼学报 ›› 2022, Vol. 36 ›› Issue (2): 51-57.doi: 10.6040/j.issn.1673-3770.0.2021.105
冯燚源,杨晶,杨洪斌
FENG Yiyuan, YANG Jing, YANG Hongbin
摘要: 目的 探讨颈深间隙感染患者临床特征、治疗体会和经验教训,提高对颈深间隙感染的诊疗水平。 方法 回顾性分析220例颈深间隙感染患者临床特征、治疗措施、预后资料。 结果 220例患者中,98例颈深间隙蜂窝织炎患者经单纯抗感染和对症支持治疗治愈88例,10例进展为颈深间隙脓肿,并经进一步脓肿穿刺或切开引流治愈。122例颈深间隙脓肿患者经抗感染联合脓肿穿刺或切开引流和对症支持治疗,其中12例结核感染性脓肿联合抗结核治疗,25例因并发严重喉阻塞行气管切开治疗,最终118例治愈,4例因严重并发症死亡。 结论 颈深间隙感染病情危重,有效抗感染联合脓肿穿刺或切开引流是治疗成功的关键,结核等特殊性感染需联合抗结核等药物治疗。及时正确处置合并症与并发症,可减少致死致残率。
中图分类号:
[1] 李旭茂, 孙广滨. 成人颈深间隙感染诊治研究进展[J]. 中国医学文摘(耳鼻咽喉科学), 2019,34(6): 431-433,423. doi:10.19617/j.issn1001-1307.2019.06.431. LI Xumao, SUN Guangbin. The study of the diagnosis and treatment of deep cervical space infection in adults[J]. Chin Med Dig Otorhinolaryngol, 2019, 34(6): 431-433,423. doi:10.19617/j.issn1001-1307.2019.06.431. [2] 罗颜, 曹忠胜, 沈红娟, 等. 严重颈深间隙感染患者病原菌分布与治疗研究[J]. 中华医院感染学杂志, 2016,26(9): 2096-2098. doi:10.11816/cn.2016-154113. LUO Yan, CAO Zhongsheng, SHEN Hongjuan, et al. Distribution of pathogens isolated from patients with severe cervical deep space infections and treatment measures[J]. Chin J Nosocomiology, 2016, 26(9): 2096-2098. [3] 杨晨, 孙祥, 丁家增, 等. 颈深部间隙感染的综合治疗(附12例报告)[J]. 外科理论与实践, 2019,24(2): 135-140. doi:10.16139/j.1007-9610.2019.02.011. YANG Chen, SUN Xiang, DING Jiazeng, et al. Comprehensive treatment of deep neck space infection: a report of 12 cases[J]. J Surg Concepts Pract, 2019, 24(2): 135-140. doi:10.16139/j.1007-9610.2019.02.011. [4] Li RM, Kiemeney M. Infections of the neck[J]. Emerg Med Clin N Am, 2019, 37(1): 95-107. doi:10.1016/j.emc.2018.09.003. [5] Celakovsky Petr, Kalfert David, Tucek Lubos, et al. Deep neck infections: risk factors for mediastinal extension[J]. Eur Arch Otorhinolaryngol, 2014, 271:1679-1683. doi: 10.1007/s00405-013-2651-5. [6] Hasegawa J, Hidaka H, Tateda M, et al. An analysis of clinical risk factors of deep neck infection[J]. Auris Nasus Larynx, 2011, 38(1): 101-107. doi:10.1016/j.anl.2010.06.001. [7] Gujrathi AB, Ambulgekar V, Kathait P. Deep neck space infection-A retrospective study of 270 cases at tertiary care center[J]. World J Otorhinolaryngol Head Neck Surg, 2016, 2(4): 208-213. doi:10.1016/j.wjorl.2016.11.003. [8] Brito TP, Hazboun IM, Fernandes FL, et al. Deep neck abscesses: study of 101 cases[J]. Braz J Otorhinolaryngol, 2017, 83(3): 341-348. doi:10.1016/j.bjorl.2016.04.004. [9] Yuvaraj V, Alexander M, Pasupathy S. Microflora in maxillofacial infections: a changing scenario?[J]. J Oral Maxillofac Surg, 2012, 70(1): 119-125. doi:10.1016/j.joms.2011.02.006. [10] 孙振龙. 糖尿病和非糖尿病患者合并颌面部间隙感染的临床比较[J]. 河南医学高等专科学校学报, 2015, 27(1): 46-47. doi: 10.3969/J.ISSN.1007-6611.2014.01.013. [11] Rana RS, Moonis G. Head and neck infection and inflammation[J]. Radiol Clin North Am, 2011, 49(1): 165-182. doi:10.1016/j.rcl.2010.07.013. [12] Pinto A, Scaglione M, Scuderi MG, et al. Infections of the neck leading to descending necrotizing mediastinitis: Role of multi-detector row computed tomography[J]. Eur J Radiol, 2008, 65(3): 389-394. doi:10.1016/j.ejrad.2007.09.024. [13] 许雯, 汤玮, 余少卿, 等. 颈部CT、超声与MRI对颈深部脓肿诊断价值的对比研究[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(7): 672-674. doi:10.13201/j.issn.1001-1781.2019.07.024. XU Wen, TANG Wei, YU Shaoqing, et al. Deep neck space infections diagnosis: a comparison between neck CT, ultrasound and MRI[J]. J Clin Otorhinolaryngol Head Neck Surg, 2019,33(7): 672-674. doi:10.13201/j.issn.1001-1781.2019.07.024. [14] Bal KK, Unal M, Delialioglu N, et al. Diagnostic and therapeutic approaches in deep neck infections: an analysis of 74 consecutive patients[J]. Braz J Otorhinolaryngol, 2020: S1808-S8694(20)30121-X. doi:10.1016/j.bjorl.2020.07.002. [15] 魏斌宏, 郭红颜, 贺玉良. 颈部结核脓肿的外科治疗[J]. 中国耳鼻咽喉头颈外科, 2011,18(2): 95-96. doi:10.16066/j.1672-7002.2011.02.003. [16] 黄方, 周小平. 口腔颌面颈部多间隙感染63例[J]. 山东大学耳鼻喉眼学报, 2020,34(6): 104-107. doi: 10.6040/j.issn.1673-3770.0.2019.559. HUANG Fang, ZHOU Xiaoping. Clinical analysis of 63 cases with multiple oral, maxillofacial, and neck infections[J]. J Otolaryngol Ophthalmol Shandong Univ, 2020, 34(6): 104-107. doi: 10.6040/j.issn.1673-3770.0.2019.559. [17] Boscolo-Rizzo P, Stellin M, Muzzi E, et al. Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment[J]. Eur Arch Otorhinolaryngol, 2012, 269(4): 1241-1249. doi:10.1007/s00405-011-1761-1. [18] Govea-Camacho LH, Astudillo-Carrera A, Hermosillo-Sandoval JM, et al. Impact of vacuum-assisted closure management in deep neck abscesses[J]. Cir Cir, 2016, 84(4): 275-281. doi:10.1016/j.circir.2015.12.004. [19] Hyun SY, Oh HK, Ryu JY, et al. Closed suction drainage for deep neck infections[J]. J Craniomaxillofac Surg, 2014, 42(6): 751-756. doi:10.1016/j.jcms.2013.11.006. [20] 朱新华, 叶吉忠, 陈珮. VSD治疗难愈性创面的临床应用[J]. 中国实用医药, 2015, 10(2): 1-3. doi:10.14163/j.cnki.11-5547/r.2015.02.001. ZHU Xinhua, YE Jizhong, CHEN Pei. Clinical application of VSD in the treatment of refractory wound[J]. China Pract Med, 2015, 10(2): 1-3. doi:10.14163/j.cnki.11-5547/r.2015.02.001. [21] George S, Ferzli MD,Punam Thakkar MD,et al. Third Branchial Cleft Cyst with Infection[J]. OTO Open, 2017. doi: 10.1177/2473974X17705832. [22] 彭利, 欧阳晖, 黄河, 等. 食管异物致穿孔并颈部脓肿的诊治[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(8): 653-654. doi:10.13201/j.issn.1001-1781.2016.08.018. PENG Li, OUYANG Hui, HUANG He, et al. The diagnosis and treatment of esophageal perforation and neck abscess induced by esophageal foreign body[J]. J Clin Otorhinolaryngol Head Neck Surg, 2016, 30(8): 653-654. doi:10.13201/j.issn.1001-1781.2016.08.018. [23] Li WX, Dong YB, Zhang AB, et al. Management of deep neck infections from cervical esophageal perforation caused by foreign body: a case series study[J]. Am J Otolaryngol, 2021, 42(2): 102870. doi:10.1016/j.amjoto.2020.102870. [24] 吴博, 胡国华. 异物致颈部脓肿三例并文献复习[J]. 山东大学耳鼻喉眼学报, 2017,31(1): 100-102,106. doi: 10.6040/j.issn.1673-3770.0.2016.341. WU Bo, HU Guohua. Foreign body induced cervical abscess in 3 cases and literature view[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2017,31(1): 100-102,106. doi: 10.6040/j.issn.1673-3770.0.2016.341. [25] Swain S, Baliarsingh P, Panda S. Deep neck space infection of the pediatric patients: Our experiences at a tertiary care teaching hospital of Eastern India[J]. Amrita J Med, 2020, 16(4): 169. doi:10.4103/amjm.amjm_52_20. [26] Sánchez-Gollarte A, Mugüerza-Huguet JM, Díez-Alonso MM, et al. Septic thrombosis of internal jugular vein: a rare cause of uncontrollable hiccups[J]. J Surg Case Rep, 2019, 2019(9): rjz266. doi:10.1093/jscr/rjz266. [27] Bendiouri R, Chennoufi I, Lachkar A, et al. Internal jugular vein thrombosis by sewing needle ingestion[J]. Int J Surg Case Rep, 2021, 83: 105988. doi:10.1016/j.ijscr.2021.105988. [28] 王卫东, 孙宏亮, 骆江红, 等. 覆膜支架腔内修复治疗颈动脉假性动脉瘤破裂出血[J]. 介入放射学杂志, 2017,26(1): 15-19. doi: 10.3969/j.issn.1008-794X.2017.01.004. WANG Weidong, SUN Hongliang, LUO Jianghong, et al. Endovascular repair with covered stent for the treatment of ruptured carotid artery pseudoaneurysms[J]. J Interv Radiol, 2017, 26(1): 15-19. doi: 10.3969/j.issn.1008-794X.2017.01.004. [29] Harada T, Fujita A, Sakata J, et al. Endovascular internal trapping by low-concentration N-butyl-2-cyanoacrylate for a ruptured giant common carotid artery pseudoaneurysm[J]. Vasc Endovascular Surg, 2021, 55(1): 81-85. doi:10.1177/1538574420953942. [30] 任昱, 肖旭平. 颈动脉损伤诊断与治疗进展[J]. 山东大学耳鼻喉眼学报, 2020,34(1): 105-109. doi: 10.6040/j.issn.1673-3770.0.2019.358. REN Yu, XIAO Xuping. Advances in the diagnosis and treatment of carotid artery injuries[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020,34(1): 105-109. doi: 10.6040/j.issn.1673-3770.0.2019.358. [31] Saito Y, Asami M, Miki A, et al. Deep neck infection complicated by phlegmonous esophagitis and mediastinitis[J]. Ann Thorac Surg, 2021, 111(6): e403-e406. doi:10.1016/j.athoracsur.2020.08.101. |
[1] | 李丹凤,陈福权,石力,王剑,许敏. 三维影像处理结合影像导航技术在进修医生鼻科围手术期教学中的应用[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 113-118. |
[2] | 龚霄阳,李旺,陈曦. 原发性咽旁间隙肿瘤67例回顾性分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 60-65. |
[3] | 张丰珍, 王桂香, 魏沄沄, 张亚梅, 赵靖, 王华, 李宏彬, 李晓丹, 张杰. 合并轻度出血性疾病的扁桃体和(或)腺样体切除术患儿围手术期管理[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 66-72. |
[4] | 张礼俊, 胥然, 罗继芳, 刘国旗, 何千, 李玮, 蒋振华. 头颈肿瘤游离皮瓣修复术后皮瓣坏死及皮瓣相关并发症影响因素分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 86-90. |
[5] | 王娟,宋英鸾,耿江桥,温鑫,史雅楠. 婴幼儿急性上颌骨骨髓炎合并鼻中隔脓肿1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 91-96. |
[6] | 王欢,胡俐,余洪猛. 慢性鼻窦炎相关嗅觉功能障碍研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 43-49. |
[7] | 资昊坤,肖旭平,李云秋. 口服糖皮质激素在慢性鼻窦炎伴鼻息肉围手术期的应用现状[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 98-103. |
[8] | 曹轩,肖旭平,李云秋. 透明质酸在慢性鼻窦炎中的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 104-109. |
[9] | 秦铭,孙占伟,王卫卫,李世超,武天义,王广科. 咽喉反流症状或体征评分阳性的慢性鼻窦炎患者鼻内镜术后碱性等渗盐水冲洗的疗效观察[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 147-153. |
[10] | 陈世琴,卫平存,胡云龙,胡金旺. 糖皮质激素三种不同鼻用法对鼻内镜术后黏膜转归的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 195-201. |
[11] | 赵笑冰,张大为,陈仁杰. 中耳间变性大T细胞淋巴瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 7-14. |
[12] | 杨扬, 王晓旭, 张杰. 儿童中耳胆脂瘤诊治进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 1-6. |
[13] | 陈坤,陆慧,黄琦,李磊,孟国珍,杨军,侯东明. 小儿先天性鼻腔鼻窦肿物的临床诊疗观察[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 81-85. |
[14] | 李莹. 重视角膜屈光手术操作规范及并发症防治[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 1-6. |
[15] | 王力翔李莹,邓应平. 全飞秒角膜基质透镜在远视屈光矫正手术中的应用[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 7-12. |
|