颈源性纵隔脓肿手术切开概率增加的危险因素分析

doi:10.6040/j.issn.1673-3770.0.2018.354

摘要/Abstract

摘要： 目的探讨颈源性纵隔脓肿手术机会增加、住院时间延长的危险因素,从而更好地判断颈源性纵隔脓肿手术治疗时机。方法回顾性分析2008年1月至2017年8月头颈部感染导致纵隔脓肿的61例患者临床资料,经Wilcoxon秩和检验得出影响住院时间的因素,采用Logistic回归模型筛选影响颈源性纵隔脓是否需要手术并延长住院时间的危险因素。结果纵隔脓肿死亡率为16.4%。糖尿病、手术治疗及脓肿最大直径≥3 cm是延长住院时间的因素(P分别为0.002、0.047、0.042)。性别、年龄、白细胞计数、发热、呼吸困难、即时手术与否与平均住院时间差异无统计学意义(P均>0.05)。糖尿病、呼吸困难及脓肿最大直径≥3 cm是增加手术治疗风险的临床危险因素(β分别为1.942、3.001、2.369,OR分别为2.565、20.099、10.979)。糖尿病患者药物治疗失败风险是无糖尿病患者的18.147倍(β=2.889,OR=18.147)。脓肿直径≥3 cm的患者药物治疗失败风险是脓肿直径<3 cm患者的57.303 倍(β=4.048,OR=57.303)。结论有糖尿病、存在呼吸困难及脓肿最大直径≥3 cm的患者需手术治疗风险增大,应积极手术干预;对无呼吸困难及脓肿最大直径<3 cm的患者,在经足量有效抗生素治疗下严密监控,可避免手术切开引流。

关键词: 隔下脓肿, 外科手术, 引流术, 回归分析

Abstract: Objective To discuss the clinical factors related to an increased risk for the requirement of surgical drainage and a prolonged length of hospital stay in cases of a deep-space neck abscess with a mediastinal abscess and to better determine the surgical treatment options. Methods The clinical data of 61 consecutive patients with mediastinal abscesses between January 2008 and August 2017 were reviewed retrospectively. The Wilcoxon rank-sum test was adopted for the analysis. Logistic regression analysis was used to study the clinical risk factors by stepwise forward regression. Results The mortality rate of the mediastinal abscess reached 16.4%. At an ɑ level of 0.05, the factors that delayed hospitalization duration included diabetes, maximum abscess dimension ≥3 cm, and surgery(W test: P=0.002, P=0.047, and P=0.042). Age sex, white blood cell count, fever, dyspnea, and timely surgery did not prolong hospitalization duration. Dyspnea increased the risk for requirement of surgical drainage(β=3.001; odds ratio ［OR］=20.099). Diabetes and maximum abscess dimension ≥3 cm increased the likelihood of not only surgical treatment(β=1.942, OR=2.565; β=2.369,OR=10.979)but also medical therapy failure(β=2.889,OR=18.147; β=4.048, OR= 57.303). Conclusion Active preoperative preparation and surgical intervention should be performed as soon as possible in patients with diabetes, dyspnea, and maximum abscess dimension ≥3 cm. However, patients without diabetes, dyspnea, and maximum abscess dimension ≥3 cm may recover without surgical incision and drainage under sufficient and effective intravenous antibiotic treatment alone with close surveillance. The result of treatment was satisfactory with surgical incision and drainage. A double-chamber tube should be a good choice. Abstraction of pus was effective and reduced surgical injury.

Key words: Subphrenic, abscess, Surgical procedures, operative, Drainage, Regression analysis

中图分类号:

R632.5

汤苏成,王跃建,陈伟雄. 颈源性纵隔脓肿手术切开概率增加的危险因素分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 87-91.

TANG Sucheng, WANG Yuejian, CHEN Weixiong. Analysis of risk factors that increase the risk for requirement of surgical incision for a mediastinal abscess after a cervical abscess[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 87-91.

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