重症颈深部多间隙脓肿的诊断与治疗策略

The diagnosis and treatment strategy for patients with severemultispace abscesses in neck

目的：分析并探讨重症颈深部多间隙脓肿患者的临床表现、病因学、影像学、治疗方式选择,提高对该病的预后判断及认识。方法：回顾性分析福建医科大学附属第一医院2010-03-2015-06期间收治30例重症颈深部多间隙脓肿患者的完整临床资料,总结其临床特征和诊疗策略。结果：咽痛、吞咽疼痛、吞咽困难、发热、呼吸困难等是颈深部多间隙脓肿最常见的症状。病因来源：牙源性5例,咽旁或食管异物4例,第2鳃裂囊肿伴多间隙脓肿1例,不明原因20例;其中6例累及纵隔。影像学上感染最常累及的间隙依次为：咽旁间隙、咽后间隙、咀嚼肌间隙、颈动脉间隙等。25例根据脓肿类型做颈侧相应部位切开引流,术腔冲洗;5例行颈部脓腔穿刺抽脓术。随访11个月-6年,29例治愈,恢复良好;1例死亡。结论：颈深部多间隙脓肿临床上需警惕,一经确诊应及时切开引流,对严重呼吸困难、气道梗阻者需行紧急气管切开术;合理使用抗生素,控制基础疾病和严重并发症发生。

Objective：To analyze the clinical characteristics of patients with severe deep neck abscess, etiology, imaging, appropriate treatment selection in those patients, to improve the judgement and understanding of the disease. Method：Thirty cases of severe deep neck abscess treated from March 2010 to June 2015 were retrospectively reviewed,including the clinical characteristics, diagnosis and treatment strategy. Result： The sore throat,odynophagia, dysphagia, fever and difficulty breathing were the most common symptoms of severe deep neck abscess. The causes of deep neck abscess were tooth diseases（5 cases）, foreign bodies in pharynx or esophagus（4 cases）, the second branchial crack cyst with multiply abscess, uncertain cause（20 cases）. Six of the above cases complicated with mediastinal abscess. Radiologic evaluation was performed on all of the patients to identify the most probable location of the abscess ： parapharyngeal space, retropharyngeal space, masticator space, carotid space, etc. Twenty-five cases were treated by drainage via incising lateral neck and 4 patientsreceived abscess puncture aspiration. Life-threatening complications were developed in all cases,29 cases were cured but one case dead. Conclusion：The treatment of severe deep neck multispace abscesses should be mindful. Once deep neck abscesses are diagnosed, we should timely undertake surgical drainage via incising lateral neck. Emergency tracheostomy should be perform in some case like severe dyspnea,airway obstrucion. Antibiotics should be appropriately applied, and basic diseases and complications should be carefully controlled.