颈深部感染95例临床分析

Deep neck infection：clinical analyses of 95 cases

目的 总结诊治颈深部感染的经验,探讨影像学评价和选择适当治疗方法的重要性.方法 回顾性分析2006年1月至2015年3月95例颈深部感染患者的临床资料.结果 95例患者的感染来源为急性化脓性扁桃体炎或咽喉炎27例（28.4％）,上呼吸道感染23例（24.2％）,牙源性感染或口腔炎症16例（16.8％）,咽喉或食管异物9例（9.5％）和急性颈淋巴结炎5例（5.3％）,不明原因15例（15.8％）;CT检查显示47例患者蜂窝组织炎,48例形成脓肿.咽旁脓肿25例,咽后脓肿9例,颌下间隙脓肿6例,颈前间隙5例,食管周围脓肿3例.并发症：纵隔脓肿2例,心包积液1例,双侧液气胸2例.上消化道大出血1例35例患者行脓液细菌培养,其中21例呈阳性.21例在抗感染治疗同时进行脓肿切开引流术,16例行CT引导下经皮穿刺置管持续引流术,5例行B超下细针穿刺抽脓;4例患者行气管切开,3例患者因出现感染性休克症状转重症监护病房治疗,1例治愈,2例死亡,1例死因为上消化道大出血,1例死因为感染性休克.结论 颈深部感染患者必须首先保证气道通畅.经抗生素治疗无效后应在24 ～48 h内进行引流或手术.影像学检查对诊断颈深部感染及选择合理的治疗方案具有重要意义.细菌培养可为制定更为有效的治疗方案及明确病因提供了可靠依据.

Objective To review the recent diagnosis and treatment experience with deep neck infection and emphasize the importance of radiologic evaluation,microbiology and appropriate treatment selection in these patients.Methods A respective review was conducted in 95 cases who were diagnosed as having deep neck from Jan.2006 to March 2015.Results The primary diseases in 95 patients with deep neck infection were acute tonsillitis or acute laryngitis （27 cases）,infection of upper respiratory tract （23 cases）,odontogenic infection or oral inflammation （16 cases）,foreign bodies in esophagus（9 cases）,acute cervical lymphadenitis （5 cases） and cause uncertain （15 cases）.Computed tomography was performed in all of patients to identify the location,extent,and character （cellulitis in 47 cases or abscesses in 48 cases） of the infections.The locations of abscess were parapharyngeal abscess （25 cases）,retropharyngeal abscess （9 cases）,submaxillary space abscess （6 cases）,pretracheal space abscess （5 cases） and esophageal abscess （3 cases）.Complications：mediastinitis （2 cases）,pericarditis （1 case）,bilateral pneumothorax （2 cases）,and upper digestive tract （1 case）.Bacterial cultivation performed in 35 patients and positive results were detected in 21.All patients were given intravenous antibiotic therapy.Tracheotomy was performed in 4 cases.Preoperative contrast enhanced CT was performed in 42 patients and indicated the formation of abscess.Three cases with the symptoms of septic shock were transferred to ICU and one was cured.All the patients were cured except two who died of massive hemorrhage of upper digestive tract and septic shock.Conclusions The airway patency in patients with deep neck infections must be ensured.Drainage may be mandatory in selected cases at presentation or in cases who fail to respond to parenteral antibiotics within the first 24-48 hours.Imaging evaluation plays a significant role in the diagnosis and rational therapeutic management in deep neck infection.Bacterial cultivation can help to make the effective treatment and provide reliable evidence for the etiopathogenisis.