负压引流联合胸腔闭式引流治疗颌面颈部多间隙感染伴下行性坏死性纵隔炎的临床观察

Clinical observation of vacuum sealing drainage combined with closed drainage under thoracoscopy on the management of maxillofacial and neck multi-space infection with descending necrotizing mediastinitis

目的:总结负压封闭引流(vacuum sealing drainage,VSD)联合胸腔镜下闭式引流治疗颌面颈部多间隙感染伴下行性坏死性纵隔炎(descending necrotizing mediastinitis,DNM)的诊疗经历,为临床提供参考。方法:回顾性分析2016年1月—2017年12月于江苏大学附属人民医院耳鼻咽喉科及口腔科治疗的3例颌面颈部多间隙感染伴DNM患者的临床资料。结果:共3例患者,男性2例,女性1例,年龄41~53岁,经颌面颈胸部CT检查确诊,均在全麻下行颈部切开VSD联合胸腔镜下闭式引流,颈部VSD装置于术后1周左右在全身麻醉下取出,胸腔闭式引流管置管约36 d,患者平均住院时间为48 d(44~57 d),术后随访33~50个月,感染未复发。结论:VSD联合胸腔镜下闭式引流治疗颌面颈部多间隙感染合并DNM,引流效果可靠、手术创伤小,患者满意,具有一定的临床应用价值。

Objective:To summarize the clinical outcomes of vacuum sealing drainage(VSD)combined with closed drainage under thoracoscopy in the management of multi-space infection of maxillofacial and neck complicated with descending necrotizing mediastinitis(DNM)and to provide clinical references.Methods:A total of 3 cases of multi-space infection of maxillofacial with DNM who were treated between January 2016 to December 2017 in Department of Otolaryngology and Department of Stomatology were included for the retrospective analysis.Results:Among 3 patients,2 males,1 female,aged from 41 to 53,diagnosis of all patients were confirmed by neck and chest CT scan.They were treated by VSD combined with closed drainage under thoracoscopy.Under general anesthesia,the device of VSD was discharged after a week,and the closed thoracic drainage tube was placed and lasted for about 36 days.The mean in-hospital day was 48 days(44-57 days),with a 33-50 months follow up.There was no recurrence of infection.Conclusion:VSD combined with closed drainage under thoracoscopy treating multi-space infection of maxillofacial with DNM has the advantage of reliable drainage,small surgical trauma and meets patients′satisfaction.It has certain clinical application value.