颈坏死性筋膜炎伴下行纵隔炎的临床特点与手术治疗

Clinical Characteristics and Surgical Treatment of Cervical Necrotizing Fasciitis Associated with Descending Necrotizing Mediastinitis

目的:探讨颈坏死性筋膜炎伴下行性纵隔炎患者的临床特点及手术方法,提高其早期诊断率及治愈率。方法:2012年12月～2016年12月我院共收治5例颈坏死性筋膜炎伴下行性纵隔炎患者,5例患者均接受颈部广泛切开引流,其中2例患者择期联合纵隔镜行纵隔引流。结果:1例患者行颈部广泛切开引流后治愈;2例患者择期联合纵隔镜引流后治愈;2例患者感染并发败血症导致多器官功能衰竭而死亡。结论:颈坏死性筋膜炎伴下行性纵隔炎进展快,死亡率高,早期诊断及颈、胸共同引流是治疗的关键,联合纵隔镜及时行颈、胸引流值得推广。

Objective：To retrospectively review 5 cases of cervical necrotizing fasciitis associated with descending necrotizing mediastinitis（CNF/DNF）,and to investigate the clinical characteristics and surgical treatment of this complex infection.Methods：Five patients,who underwent extensive cervical drainage,were identified from December 2012 to December 2016.Besides,two of them underwent the two-stage mediastinoscope drainage of mediastinum.Results：One patient was successfully treated after extensive cervical drainage,while other two patients who did not get efficient drainage of mediastinum were died of multiorgan failure related to septic shock.The rest patients who had undergone the two-stage mediastinoscope drainage of mediastinum were successfully treated.The mortality rate was 40%.Conclusion：High mortality is found in this complex infection.As it progresses quickly,prompt diagnosis and surgical treatment are essential for reducing mortality in CNF/DNM.Extensive cervical drainage and transthoracic drainage should be performed simultaneously without delay.Cervical drainage and mediastinoscope drainage is worthy of promotion.