颈深部多间隙脓肿23例临床分析

Clinical analysis of 23 cases of multiple deep neck abscess

目的总结分析颈深部多间隙脓肿的临床特点和治疗方法,为临床诊疗提供参考。方法回顾性分析重庆市涪陵中心医院2015年1月~2019年3月收治的23例颈深部多间隙脓肿患者的临床资料。总结其临床特征、实验室检查、影像学特点及微生物学检查结果。分析归纳病因,总结诊疗经过并追踪预后。结果23例病例中感染来源于牙源性10例,扁桃体4例,腮腺2例,异物感染2例,不明原因5例。感染部位以下颌下间隙最常见,其次是咽旁间隙。病原学培养11例(47.82%)阳性,其中A型溶血性链球菌3例,肺炎克雷伯杆菌4例,流感嗜血杆菌2例,鲍曼不动杆菌伴白色念珠菌1例,抗酸染色阳性并查见结核杆菌1例。所有病例在抗生素治疗的基础上均行脓肿切开引流术,其中15例同期行气管切开术预防窒息。治愈20例(86.96%),死亡2例(8.70%),1例(4.34%)放弃治疗后失访。结论颈深部多间隙脓肿是一凶险疾病,起病急、向周围扩散快。颈部增强CT或彩超有助于本病的诊断和进展的监测,及时切开引流是治疗的关键。窒息是导致死亡的常见原因,对重症患者行预防性气管切开可降低因突然窒息而死亡的风险。

OBJECTIVE Summarize the clinical feature,diagnosis and treatment strategy for patients with multiple deep neck abscess,so as to provided references for clinical diagnosis and treatmen.METHODS A respective review was conducted in 23 cases who were diagnosed as multiple deep neck abscess from January 2015 to March 2019.So we can summarize the clinical characteristics,results of lab examination,imaging characteristics and microbiological examination results,analyze the etiology,summarize the diagnosis and treatment process and follow up the prognosis.RESULTS Among the 23 cases with multiple deep neck abscess,10 cases originated from odontogenic infection,4 cases from tonsil infection,2 cases from parotid infection,2 cases from foreign body in throat,and 5 cases from unknown causes.The most common site of infection was the submandibular space,and the next was the parapharyngeal space.Eleven of 23 cases(47.82%)were positive in pathogenic culture,including 3 cases of hemolytic streptococcus type A,4 cases of Klebsiellapneumoniae,2 cases of Haemophilusinfluenzae,1 case of Acinetobacterbaumannii with Candida albicans,1 case of Mycobacterium tuberculosis.On the basis of antibiotic treatment,all 23 cases underwent abscess incision and drainage,and 15 cases underwent tracheotomy at the same time in order to prevent asphyxia.After treatment,20 cases(86.96%)were cured,2 cases(8.7%)died,and 1 case was lost to follow-up after giving up treatment.The causes of death were sudden asphyxia caused by severe infection in other departments and failed to rescue by emergency tracheotomy.CONCLUSION Multiple space abscess in deep neck is a dangerous diseasewith acute onset and rapid spread around.Enhanced CT or color Doppler ultrasound is helpful for the diagnosis and monitoring the development of the disease.Timely incision and drainage is the key to treatment,and asphyxia is a common cause of death.Prophylactic tracheotomy for severe patients can reduce the risk of death due to sudden asphyxia.