儿童颈深间隙脓肿28例临床分析

Clinical analysis of 28 cases with pediatric deep cervical fascial space abscess

目的探讨儿童颈深间隙脓肿的临床特点和治疗方法。方法回顾分析28例儿童颈深间隙脓肿的临床资料。全部病例均行相应外科处理,同时取脓液做细菌培养,并选用敏感抗生素进行抗感染治疗。随访2个月以上。结果儿童颈深间隙脓肿常见的病因为化脓性淋巴结炎、鳃源性瘘管或囊肿、咽部异物;常见致病菌为包括耐甲氧西林金黄色葡萄球菌(MRSA)的葡萄球菌属、链球菌属及厌氧菌。28例脓肿首次治疗后3例复发,1例术后出现Horner综合征。结论儿童咽部异物引起的颈深间隙脓肿容易因异物史不明确对治疗及预后造成影响。鳃源性瘘管或囊肿是儿童颈深间隙脓肿发病的重要因素。脓肿引流后予及时切除可减少复发。经体表或经口切开引流不畅时,可经颈外入路行脓肿切除,治疗效果良好,具有一定的临床应用价值。

Objective To investigate the clinical characteristics and treatment of pediatric deep cervical fascial space abscess. Methods Clinical data of 28 cases of pediatric deep cervical fascial space abscess were analyzed retrospectively. All the patients underwent proper surgery and were treated with antibiotics according to the results of antimicrobial susceptibility test. All the patients were followed up for at least 2 months. Results The most common pathogenesis of pediatric deep cervical fascial space abscess included suppurative lymphadenitis, branchial fistula or branchial cleft cyst, and pharyngeal foreign body. Streptococcus including MRSA, Staphylococcus and anaerobia were the most common pathogenic bacteria. Relapse occurred in 3 patients after the first treatment and 1 case complicated with Homer syndrome postoperatively. Conclusions In children, uncertainty of pharyngeal foreign bodies may have negative effect on the treatment and prognosis of deep cervical fascial space abscess. Branchial fistula or cleft cysts were the important factors of pediatric deep cervical fascial space abscess and the resection of them in time after drainaging could reduce the relapse. External cervical surgical approach could be performed when surface drainage or oropharynx surgical approach was ineffective.