70例牙源性下行性坏死性纵隔炎临床分析

Clinical analysis of 70 cases of odontogenic descending necrotizing mediastinitis

目的 :分析牙源性下行性坏死性纵隔炎患者的临床特征,为诊断和治疗提供参考。方法 :回顾分析2014年1月—2016年12月上海交通大学医学院附属第九人民医院收治的牙源性下行性坏死性纵隔炎患者,收集、分析患者的一般资料、感染来源、临床症状、实验室检查、细菌培养、治疗和预后。采用SPSS 22.0软件包对数据进行统计学分析。结果:本组70例患者中,男57例,女13例,平均年龄57.8±11.42岁。主要的发病来源为下颌前磨牙及第一、第二磨牙(38.6%)。根尖周炎是最常见的牙源性感染的病因。治疗包括抗生素和经颈部纵隔引流(63例)、胸廓切开术(7例)。死亡率为5.7%。影响牙源性下行性坏死性纵隔炎患者预后的危险因素为发生并发症(P<0.005)和严重脓毒症或败血性休克(P<0.002)。结论:成功治疗牙源性下行性坏死性纵隔炎的关键是对疑似症状的迅速诊断、快速CT扫描和彻底的纵隔引流。

PURPOSE： To analyze the clinical features of patients with odontogenic descending necrotizing mediastinitis（DNM） in order to provide prompt diagnosis and treatment. METHODS： A retrospective study was conducted on 70 patients receiving treatment for odontogenic DNM from January 2014 to December 2016. Demographics, etiology of infection, clinical symptom, laboratory tests, bacterial cultures, treatment and outcomes were collected and analyzed.Statistical analysis of the results was performed using SPSS 22.0 software package. RESULTS： There were 57 males and13 females, with a mean age of 57.8 ±11.42 years. The most frequent teeth involved were the lower posterior molars（38.6%）. Periapical periodontitis was the most frequent triggering cause in 50 cases. Treatments consisted of antibiotic therapy and aggressive transcervical drainage（63 cases） and thoracotomy（7 cases）. The mortality was 5.7%. The risk factors for mortality were associated complications（P 0.005） and severe sepsis or septic shock（P 0.002）.CONCLUSIONS： Success in management of odontogenic DNM is based on prompt identification of suspected symptoms,quick CT scanning and aggressive mediastinal drainage.