46例严重坏死性、化脓性颈深部感染伴脓腔内积气的临床分析

Clinical Analysis of Badly Necrotic Pyogenic Infection in Cervical Part with Pneumatosis of Vomica

目的 探讨严重坏死性、化脓性颈深部感染伴脓腔内积气患者的临床特征及其诊断治疗。方法 回顾总结了 4 6例严重坏死性、化脓性颈深部感染伴脓腔内积气患者的临床特点、诊断和治疗。结果 4 6例患者中 ,一侧颈深部脓肿伴积气 38例 ,两侧颈深部脓肿伴积气 8例 ;原发颈深部脓肿伴积气 30例 ,源于其他邻近部位而继发颈深部化脓性感染伴积气 16例。临床表现除局部及全身急性感染症状外 ,颈部感染局部的积气征为其显著特点。B超、CT能清楚显示颈深部脓肿的大小、范围、积气多少、脓腔与颈部重要结构及邻近重要器官的比邻关系。 4 6例患者术前均作了诊断性穿刺 ,术前、术中脓液细菌常规培养结果显示 :4 6例患者中金黄色葡萄球菌或溶血性链球菌感染 (包括二者合并厌氧菌感染 ) 2 5例 ,其他类细菌感染 2 1例。 4 6例患者均行脓肿切开引流及脓腔探查术 ,术后 2例死亡 ,余均治愈出院。结论 CT、B超、诊断性穿刺对颈深部积气性、化脓性感染的术前诊断和系统性治疗具有重要意义 ,手术引流后细菌培养为明确病因及制定有效的治疗方案提供了可靠依据。脓腔积气的主要原因可能在于 :产气菌的作用、颈胸部联合感染、咽部感染随吞咽运动产生积气。

Objective To analyze the clinical character, diagnosis and treatment of badly necrotic pyogenic infection in cervical part with pneumatosis of vomica.Methods The clinical character, diagnosis and treatment of badly necrotic pyogenic infection in cervical part with pneumatosis of vomica of 46 cases were investigated retrospectively.Results Lateral and bilateral neck infection cases were 38 and 8 respectively. 30 cases formed primary pyogenic infection in cervical part with pneumatosis of vomica, and 16 did from adjacent sites. Besides the characters of the acute infection, gas storage in deep cervical part abscess was notable. CT and B Ultrasonic examination provided useful informations such as sizes, shapes, capacity, extents of abscess and the relationship between the abscess and vessel or vital organ. Diagnosis puncture and germiculture were performed before and after operation. The results showed that 25 of 46 cases were infected by staphylococcus or streptococcus, and 21 cases did by other bacterium. Exploration and drainage treatments were performed. All cases were cured except 2 died.Conclusion Diagnostic puncture, CT and/or B Ultrasonic examination are essential for diagnosis and presurgical planning. Germiculture provides reliable evidence for finding pathogeny and therapy. The most possibilities of pyogenic infection with pneumatosis of vomica in cervical part are the action of aerogenic bacterium, infection both in cervical part and chest or swallowing movement of pharynx.