粪肠球菌致甲状软骨破坏的喉脓肿1例并文献复习

Laryngeal abscess with destruction of thyroid cartilage caused by enterococcus faecalis:a case report and literature review

目的 总结1例粪肠球菌致甲状软骨破坏的喉脓肿病例,提高对喉脓肿的认识,争取早诊断、正确治疗。方法 分析1例粪肠球菌致甲状软骨破坏的喉脓肿病例,并复习相关文献进行总结。结果 检索1980~2022年国内外发表的相关文献,包括本例共21例患者16篇文献被纳入研究,患者的平均年龄为51岁(19~72岁),男性多于女性(14/21),症状以声音嘶哑(12/21)、呼吸困难/喘鸣(8/21)、吞咽困难(5/21)为主。主要诱因为上呼吸道感染(4/21)、各种原因导致的免疫抑制(3/21)、糖尿病(2/21)、喉部手术(2/21),以及结核病、头颈部外伤、误入异物、放射性损伤各1例。喉脓肿并发喉癌5例。脓液细菌培养结果,分别为铜绿假细胞单菌(3/21)、耐甲氧西林金黄色葡萄球菌(1/21)、法氏诺卡菌(1/21)、结核杆菌(1/21)、粪肠球菌(1/21)、肺炎克雷伯菌、铜绿假单胞菌及阴沟肠杆菌混合感染(1/21);侵袭喉部软骨部位,分别为甲状软骨(4/21)、杓状软骨(2/21)、环状软骨(1/21)。主要治疗方式有脓肿引流(13/21)、气管切开术(10/21)、喉部分切除术(7/21,2例为喉癌患者)、(扩大)全喉切除(3/21,均为喉癌患者)、CO_(2)激光手术(2/21)。结论 喉脓肿主要诱因为上呼吸道感染,可并发喉癌。最常见的症状是声音嘶哑,会导致不同程度的气道阻塞甚至声带固定,需做好气管切开术的准备;当脓肿合并有软骨破坏时,须详细了解患者的症状、体征并完善内镜及各项影像学检查结果,结合患者的病情变化,诊断或排除喉恶性肿瘤从而做出具体的治疗方案,且适时施行手术可彻底清除病变、明确诊断、优化最终功能结果。

Objective We summarized a case of laryngeal abscess with destruction of the thyroid cartilage caused by enterococcus faecails to improve the understanding of the disease and achieve early diagnosis and appropriate treatment.Methods The clinical data of a patient who had laryngeal abscess with destruction of the thyroid cartilage caused by enterococcus faecails was retrospectively analyzed.Additionally,a summarized systematic review of related literature was included.Results Twenty-one patients with laryngeal abscess were enrolled in the study,including the present case and cases from sixteen relevant literature published in Chinese and English between 1980 and 2022.The mean age at the time of presentation was 51 years(range 19-72 years),and males were more than females(14:7).The main symptoms were hoarseness(12/21),dyspnea/wheezing(8/21),and dysphagia(5/21).The predisposing factors included upper respiratory tract infection(4/21),immunosuppression of various etiologies(3/21),diabetes(2/21),laryngeal surgery(2/21),tuberculosis(1/21),head and neck trauma(1/21),accidental foreign body aspiration(1/21),and radiation injury(1/21).It was complicated by laryngeal carcinoma in five patients.The pus was extracted for bacterial culture to determine the causative pathogen;this yielded pseudomonas aeruginosa(3/21),methicillin-resistant staphylococcus aureus(1/21),nocardia farreri(1/21),mycobacterium tuberculosis(1/21),enterococcus faecalis(1/21),klebsiella pneumoniae,pseudomonas aeruginosa,or enterobacter cloacae mixed infection(1/21).The laryngeal cartilage affected was mainly the thyroid cartilage(4/21);the arytenoid cartilage(2/21)and cricoid cartilage(1/21)were also affected.Treatment methods included abscess drainage(13/21),tracheotomy(10/21),partial laryngectomy(7/21,2 patients with laryngeal cancer),total(extended)laryngectomy(3/21,all patients with laryngeal cancer),and CO_(2) laser surgery(2/21).Conclusion The main risk factor for laryngeal abscess is upper respiratory tract infection.Laryngeal abscess can be complicated by laryngeal cancer.The most common symptom of laryngeal abscess is hoarseness,which may lead to airway obstruction or even different degrees of vocal cord fixation.Therefore,preparedness to perform tracheotomy is necessary at all times.When laryngeal abscess occurs concurrently with laryngeal cartilage destruction,detailed knowledge of the associated symptoms and signs and confirmation with endoscopic and imaging examination are required.The best therapeutic approach can be determined based on the patient's condition,and it is necessary to differentiate the diagnosis from the laryngeal tumor.Surgery should be performed in a timely to completely remove the lesions,clarify the diagnosis,and optimize the final functional outcomes.