非胸伤纵隔气肿的病因及治疗

Etiology and treatment of non-thoracotraumatic pneumomediastinum

目的探讨非胸部创伤及非胸部手术所致纵隔气肿的病因、发病机制和治疗措施。方法56例非胸伤性纵隔气肿按其发病原因分为特发性37例（66．1％），下行性11例（19．6％），上迁性8例（14．3％）3类。根据原发病变（口咽颈、肺支气管、结肠）采取针对病因治疗及纵隔切开引流等减状治疗。结果临床症状完全缓解45例（80．4％），部分缓解5例（8．9％），死亡6例（10．7％）。死因为肺部重度感染、呼吸衰竭2例，下行性坏死性纵隔炎并多器官功能衰竭3例，结肠穿孔并脓毒症1例。结论非胸部创伤性纵隔气肿多为继发性，其产生机制为肺间质径路（特发性）、口咽及颈部间隙径路（下行性）、腹膜外间隙径路（上迁性），其治疗重点是处理原发疾病并行纵隔切开引流等减状治疗。

Objective To investigate the etiological factors, pathogenesis, and treatment of pneumomediastinum not caused by thoracic injury and chest operation. Methods 56 patients with nonthoracotraumatic pneumomediastinum were divided into 3 groups according to etiology： idiopathic pneumomediastinum （ n = 37 ）, descending pueumomcdiastinum （ n = 11 ） and ascending pneumomediastinum （n = 8 ）. All of 56 patients received symptomatic treatment by mediastinotomy and etiological treatment on the basis of different primary affection of mouth, throat, neck, bronchus, colon etc. Results Complete recovery was observed in 45 patients and partial recovery was found in 5 patients. The causes of death in 6 patients were serious pulmonary infection with respiratory failure, descending necrotizing mediastinitis with multi-organ failure and colonic perforation with septicopyemia. Conclusion Most nonthoracotraumatic pneumomediastinum are secondary to the underlying diseases, the mechanisms of its pathogenesis include lung interstitium path （idiopathic）, oropharyngeal and cervical interspace path （descending）, and extraperitoneal space path （ascending）. The treatment should be focused on dealing with primary diseases as well as symptomatic treatment by mediastinotomy.