食管后间隙脓肿的临床诊治分析

Clinical analysis of diagnosis and treatment on retro-esophageal space abscess

目的:探讨食管后间隙脓肿的临床表现及治疗方法。方法:对27例食管后间隙脓肿患者的临床资料进行回顾分析。21例(77.78%)继发于急性食管入口处异物损伤,2例(7.41%)继发于陈旧性食管后间隙异物感染,3例(11.11%)继发于咽后脓肿,1例(3.70%)原因不明。全部患者行断层影像学检查确诊。其中6例患者进行保守治疗(保守组),6例患者行咽内切开排脓术(咽内组),15例患者经颈外切口行切开排脓闭式负压引流术(颈外组)。结果:保守组6例均治愈,平均住院时间15.6d;咽内组有5例治愈,其中2例出现吸入性肺炎并发感染性休克;余1例并发纵隔脓肿及肺脓肿感染性休克死亡,本组患者平均住院时间18.8d;颈外组患者全部治愈,无并发症,平均住院时间9.5d。结论:食管上段异物损伤及食管后间隙异物残留是食管后间隙脓肿的主要诱因。断层影像学检查能充分显示食管后间隙脓肿与其他颈深部间隙,对诊断及治疗有重要价值。经颈外切口行切开排脓闭式负压引流术是有效治疗方法;经咽内切口排脓效果差,易导致误吸诱发吸入性肺炎,不提倡做首选治疗方法;保守治疗对于一些无呼吸困难的无基础病患者也是一种选择,但需重视对严重并发症的早期认识及处理。

Objective：To explore the clinical manifestations and treatments of retro-esophageal space abscess. Method：The clinical data of 27 cases with retro-esophageal space abscess were analyzed retrospectively. Twenty- one cases （77.78%） were secondary to acute injury of esophageal meatus caused by foreign bodies. 2 cases （7.41%） were secondary to old foreign body infection in retro-esophageal space, 3 cases （11.11 % ） after secondary to pharyngeal abscess, and 1 case （3.70%） was unknown to etiology. All patients were confirmed by sectional medicalimageology. Six cases（Conservation group, C group） were treated conservatively and 6 cases （Oropharyn- geal incision group, OI group） were performed with oropharyngeal incision drainage. 15 cases（Extra-neck incision group, ENI group） were performed with extra-neck incision and vacuum sealing drainage. Result ： In C group, 6 ca- ses were cured with conservative therapy and the average hospital stay was 15.6 days. In OI group, 5 cases were healed with oropharyngeal drainage but aspiration pneumonia complicated with septic shock occurred in 2 cases, and 1 case dead from septic shock secondary to mediastinum and lung abscess. The average hospital stay was 18.8 days. In ENI group, 15 patients were cured with extra-neck drainage without complication and the average hospi- tal stay was 9.5 days. Conclusion：The main causes of retro esophageal space abscess are foreign body iniury of up- per esophagus and remnant of retro-esophageal space. Sectional medicalimageology can be of important value of di- agnosis and treatment for displaying the retro-esophageal space abscess and other deep cervical fascia space suffi- ciently. Incision and vacuum sealing drainage via extra-neck is an effective therapy while oropharyngeal drainage is less effective and is not advocated as a primary treatment because of aspiration pneumonia complication. Conserva- tive cure is a choice for patients without dyspnoea and background diseases, and it is necessary to recognize and treat severe complications early.