牙源性颈深部多间隙及纵隔脓肿2例并文献复习

doi:10.6040/j.issn.1673-3770.0.2023.052

摘要/Abstract

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。

关键词: 颈深部间隙脓肿, 纵隔脓肿, 气管切开, 牙源性感染

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 understanding 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.

Key words: Deep cervical interstitial abscess, Mediastinal abscess, Tracheotomy, Odontogenic infection

中图分类号:

R768

宋攀攀,赵玉凤,张瑶瑶,丁德涛,张加夫,张辉,张瑾,吴允刚. 牙源性颈深部多间隙及纵隔脓肿2例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(3): 93-96.

SONG Panpan, ZHAO Yufeng, ZHANG Yaoyao, DING Detao, ZHANG Jiafu, ZHANG Hui, ZHANG Jin, WU Yungang. Two cases of odontogenic deep cervical multi-space and mediastinal abscess and literature review[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(3): 93-96.

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