• 作者：Clara Isabel Bayarri Lara ; Sebasti¨¢n Sevilla L¨®pez ; Abel S¨¢nchez-Palencia Ramos ; Amira Alkourdi Mart¨ªnez ; Francisco Hern¨¢ndez Escobar ; Florencio Quero Valenzuela ; Francisco Javier Ruiz Zafra ; Antonio Cueto Ladr¨®n de Guevara
• 关键词：Mediastinitis necrosante descendente ; Mediastino ; Tratamiento quirú ; rgico
• 刊名：Ciruga Espa?ola
• 出版年：2013
• 出版时间：November, 2013
• 年：2013
• 卷：91
• 期：9
• 页码：579-583
• 全文大小：451 K

Introduction

Descending necrotizing mediastinitis (DNM) is a serious infection which occurs as a complication of oropharyngeal infection. Its surgical management and the routine transthoracic approach remain controversial. In this article we report our experience in the management of this disease, and review the different surgical approaches that have been reported in the medical literature.

Material and methods

A retrospective review was made of the clinical records of 29 patients treated between 1988 and 2009. Several demographic variables were analyzed, origin of the initial infection, stage of the disease according to Endo's classification, surgical technique and outcome.

Results

Surgical treatment consisted of both cervical and mediastinal drainage and radical debridement. The mediastinal drainage was made through a transcervical approach in 10 cases and transthoracic in 19, depending on the extent of the mediastinitis. The outcome was satisfactory in 24 patients and 5 died (mortality 17.2 % ).

Conclusions

According to our results and the conclusions of the main authors, we recommend a prompt and aggressive surgery with a transthoracic approach in cases of widespread DNM.