负压封闭引流术治疗牙源性颌面-颈部-纵膈感染5例临床分析

Clinical analysis of 5 cases of odontogenic maxillofacial-neck-mediastinal infection treated with negative pressure sealing drainage

目的探讨应用负压封闭引流(vacuum sealing drainage,VSD)术治疗颌面-颈部-纵隔多间隙感染的临床疗效。方法5例由牙源性感染导致的颌面-颈部-纵隔多间隙感染,同时伴有糖尿病或肾功能衰竭等全身疾病的患者,在手术广泛清创后采用VSD于脓腔放置负压引流海绵并关闭伤口,术后持续负压引流;同时多学科会诊控制基础性疾病,加强抗炎、营养等全身治疗。结果4例患者经过持续负压引流,症状消退后成功拔除负压海绵。1例患者术后感染症状加重,再次手术更换负压海绵放置位置后感染症状逐渐消失。5例患者治疗期间均进行了1~3次不等的VSD负压海绵更换,经抗炎及治疗全身基础性疾病,术后均治愈出院。结论对于牙源性颌面颈部纵隔多间隙感染,强调局部治疗与全身治疗、感染病灶与基础病治疗并重,VSD术促进了炎症消退,多学科联合治疗有益于控制基础性疾病。

Objective To explore the effect of negative pressure sealing drainage on the treatment of maxillofacial-neck-mediastinal infection in multiple spaces.Methods Vacuum sealing drainage(VSD)was applied in five patients with maxillofacial-neck-mediastinal infection caused by odontogenic infection accompanied by diabetes or renal failure and other systemic diseases.After extensive debridement,a negative pressure drainage sponge was placed in the pus cavity and then the wound was closed.Continuous negative pressure drainage was continued after the operation.At the same time,multidisciplinary consultation was applied to control basic diseases and,strengthen anti-inflammatory re-sponses,and nutrition and other systemic treatments were applied.Results Four patients underwent continuous nega-tive pressure drainage and successful removal of the negative pressure sponge after inflammatory symptoms subsided.One patient′s inflammatory symptoms became more serious after the operation,and we performed another operation to change the placement of the negative pressure sponge.All 5 patients underwent VSD with negative pressure sponge replacement ranging from 1 to 3 times during treatment.After multidisciplinary consultation,they were all cured and dis-charged from the hospital.Conclusion For infection of the mediastinum,maxillofacial region and neck,local treatment and systemic treatment are emphasized,as well as the treatment of infected lesions and basic diseases.Negative pressure closure and drainage technology promotes the alleviation of inflammation,and multidisciplinary combined treatment is beneficial for the control of basic diseases.