颈部坏死性筋膜炎诊治的回顾性分析

Cervical Necrotizing Fasciitis: a Retrospective Review of 11 Cases

目的:探讨颈部坏死性筋膜炎的急诊救治与处理。方法 :收集解放军第252医院6年间,诊断为颈部坏死性筋膜炎的病例共11例,男性8例,女性3例。所有患者接受全面的临床体检、实验室检查、CT检查,确诊后急诊手术切开引流。分析患者的主要临床症状和体征、存在的系统疾病、影像学表现、实验室检查结果、手术操作和预后等临床特征。结果:颈部坏死性筋膜炎的主要症状和体征包括疼痛、颈部活动受限、发热、颈部弥漫性肿胀、呼吸道梗阻、感染性休克。11例患者血浆白蛋白水平均有明显下降,8例有明显的白细胞计数和中性粒细胞比例异常,4例伴有糖尿病。影像学表现最显著的特征是颈筋膜间隙积气和周围软组织肿胀。手术的典型表现为筋膜坏死,术后转入重症监护病房,最终成功救治8例,死亡3例。结论:颈部坏死性筋膜炎是一种进展迅速、高致死率的感染性疾病。早期的诊断和急诊手术干预,并联合全身支持治疗,可能提高其临床治愈率。

Objective： To review the clinical emergency management of cervical necrotizing fasciitis（CNF） patients. Methods：11 CNF patients（8 males, 3 females） with were retrospectively reviewed. All the patients underwent comprehensive physical examination, CT evaluation and laboratory examination. After a confirmed diagnosis, emergency surgical incision and drainage were performed. Characteristics were analyzed including clinical symptoms and signs, systemic diseases, radiological manifestations, laboratory examination, surgical findings, and treatment outcomes. Results： The main symptoms and signs of CNF included pain, dysphasia, fever, swelling, airway obstruction, and septic shock. Laboratory findings showed,all cases had a significantly reduction in plasma albumin level. 8 cases had abnormal white blood cell count and neutrophil ratio, 4 cases had diabetes mellitus. The most predominant CT findings was gas formation along fascial planes and irregular jagged edge around the gas chamber. The typical surgical findings included infection spreading along fascial planes and lack of bleeding of the fascia during dissection. 3 patients died of functional failure of multiple organs with an overall mortality rate of 27.3%. Conclusion： CNF is an aggressive infection associated with high mortality. Early diagnosis and aggressive debridement combined with general support therapy may reduce mortality rate.