111例下行性坏死性纵隔炎的诊断与治疗

Diagnosis and treatment of descending necrotizing mediastinitis in 111 patients

目的 :探讨下行性坏死性纵隔炎的临床特点、早期诊断和治疗方法 ,以降低该病的死亡率。方法 :回顾分析2013年1月—2016年10月于上海交通大学医学院附属第九人民医院诊治的下行性坏死性纵隔炎病例,总结其性别、年龄、合并症、感染源、影像学检查结果、细菌学检查结果、治疗手段和治疗结果。结果:共收集111例患者,平均年龄56.6±12.5岁,男女比为5.9:1。主要感染源为牙源性感染,其次为腺源性感染。52例(46.8%)患者有合并症,其中以Ⅱ型糖尿病最常见。所有患者均行颈胸部CT检查。主要致病菌为链球菌。所有患者均行全身抗感染治疗和颈部切开排脓,106例患者经颈部切口行上纵隔引流,9例行开胸手术清创引流。死亡率为6.3%。结论:胸部CT检查是早期诊断下行性坏死性纵隔炎的有效手段。早期诊断、有效的抗菌治疗、充分的切口引流及全身支持治疗是降低死亡率的主要措施。

PURPOSE： To explore the clinical manifestation and early diagnosis and treatment of descending necrotizing mediastinitis, in order to decrease its mortality. METHODS： We retrospectively reviewed 111 patients with DNM who were treated in Shanghai Ninth People＇s Hospital from January 2013 to October 2016. The clinical data were recorded,including sex, age, comorbidities, original infections, imaging results, microbiological examination, treatment, and outcomes. RESULTS： A total of 111 patients were collected in the study, with an average age of 56.6±12.5 years. The male-to-female ratio was 5.6∶1. The main source of infection was odontogenic infection, followed by glandular infection. There were 52 patients （46.8%） with comorbidities, with diabetes mellitus being the most common. The main pathogen was Streptococcus. All patients received antibiotic therapy and drainage for abscess in cervical region. 106 patients underwent mediastinal drainage with transcervical incision, and 9 patients underwent thoracotomy. The mortality rate was 6.3%. CONCLUSIONS： Chest CT is an effective tool for early diagnosis of descending necrotizing mediastinitis. At the same time, early efficacious antibacterial treatment, aggressive surgical debridement and supportive therapy are the key factors in reducing mortality of descending necrotizing mediastinitis.