摘要
目的:探讨口腔颌面部感染引发颈深部及纵隔感染的临床表现、治疗和转归。方法:回顾分析1998～2005年在我科就诊的6例患者,分析其感染来源、相关全身疾病、细菌培养结果、并发症及治疗结果。结果:6例患者中,男4例,女2例,年龄30～82岁,平均年龄47岁。感染来源分别为牙源性感染4例(下颌第三磨牙冠周炎),上呼吸道感染1例,1例原因不明,2例伴有糖尿病。临床主要表现为双侧下颌下、颈部广泛肿胀,脓肿形成,同时伴有胸前区充血、肿胀及脓液渗出。X线及CT检查显示,4例纵隔及胸腔内有脓肿形成。细菌培养结果以杆菌为主。经广泛局部切开引流、胸腔引流及抗生素治疗后,4例痊愈,2例死亡(死亡率33.3%)。结论:口腔颌面、颈深部及纵隔感染死亡率较高;胸部增强CT扫描对早期诊断有很高的价值;一旦确诊,应及早行多部位切开引流和胸腔引流;细菌培养对抗生素应用具有重要指导意义,而支持治疗和多学科协助治疗是成功抢救的关键。
PURPOSE： The aim of this study is to retrospectively review 6 cases of maxillofacial and cervical infections with descending mediastinitis, and to investigate the clinical manifestations, radiographic features, bacteriologic tests, treatment and prognosis of this complex infection. METHODS： 6 patients were identified from December 1998 to June 2005, and the etiology, associated systemic diseases, clinical manifestation, bacteriology, complications and treatment outcomes were analyzed. RESULTS： Of them, 4 were male and 2 were female. The average age was 47 years （ranging from 30 to 82 years）. 2 patients also had diabetes. 4 of the 6 patients resulted from odontogenic infections （pericoronitis of the third molar of the mandible）, 1 resulted from upper airway infection, and 1 had unknown causes. Diffuse swelling in bilateral submandibular and cervical region and abscess formation were the main clinical findings, which was followed by swelling and hyperemia in the front of the chest. Chest radiography showed a widening of the upper nledlastinal shadow in 4 of 6 patients. 4 patients underwent CT scanning that displayed abscess in the mediastinum. Pus and blood culture results showed that bacillus was the main pathogen isolated. Under extensive surgical drainage, thoracic drainage and large doses of antibiotics, 4 patients were successfully treated while two died （33.3%）. CONCLUSIONS： High mortality is found in this complex infection. Early diagnosis should be made through clinical and radiographic examinations, Extensive surgical drainage remains the mainstay for the treatment of deep cervical infection with mediastinitis. Bacteriologic culture is very helpful for selection of antibiotics. Supportive therapy and muhidiscipllnary approach is the key to salvage the patients and to decrease mortality. Supported by Shanghai Leading Academic Discipline Project （Grant No.Y0203）.
出处
《中国口腔颌面外科杂志》
CAS
2006年第6期408-411,共4页
China Journal of Oral and Maxillofacial Surgery
基金
上海市重点学科(优势学科)建设项目(Y0203)
关键词
纵隔感染
颈深部感染
诊断
治疗
Mediastinitis Deep cervical infection Diagnosis Treatment
