颈深部间隙感染的综合治疗(附12例报告)
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摘要
目的:探讨颈深部间隙感染(deep neck space infection, DNI)的综合治疗。方法:回顾性分析瑞金医院耳鼻咽喉科2005年1月至2018年9月间收治12例DNI病人的临床资料和诊疗方法。结果:12例病人中,4例合并糖尿病,咽痛为最多见首发症状。所有病人均经颈部CT检查明确DNI诊断。咽旁间隙是最多受累的颈深部间隙。8例因脓肿形成行颈部切开脓肿引流,其中1例切开引流合并CT引导下经皮穿刺脓肿引流。3例同时行气管切开。所有病人均予以静脉抗生素治疗,5例留置鼻胃管营养。12例病人平均住院时间(29.1±7.3) d,11例治愈,1例死亡。结论:早期足量全身使用广谱抗生素、适时选择恰当的引流手术、气道管理和营养支持是DNI综合治疗的关键。
Objective To investigate the comprehensive treatment of deep neck space infection. Methods The clinical data of 12 patients with deep neck space infection were retrospectively analyzed in Department of Otolaryngo-logy, Ruijin Hospital from January 2005 to September 2018. Results Four cases had concurrent diabetes mellitus and pharyngalgia was the most common and first-episode symptom. All patients were diagnosed as deep neck space infection by neck CT scan. The parapharyngeal space was the most involved among deep neck spaces. Eight patients underwent abscess dissection including one case with dissection in one space and CT-guided percutaneous aspiration and drainage in another space. Three patients underwent tracheotomy simultaneously. Intravenous antibiotics was given all patients and nasogastric feeding in 5 patients. Hospital stay was(29.1 ±7.3) days. Totally 11 patients were cured and 1 patient died. Conclusions It is indicated in this study that early and adequate use of broad-spectrum antibiotics, timely drainage, airway management and nutritional support are the key to treat deep neck space infection comprehensively.
Objective To investigate the comprehensive treatment of deep neck space infection. Methods The clinical data of 12 patients with deep neck space infection were retrospectively analyzed in Department of Otolaryngo-logy, Ruijin Hospital from January 2005 to September 2018. Results Four cases had concurrent diabetes mellitus and pharyngalgia was the most common and first-episode symptom. All patients were diagnosed as deep neck space infection by neck CT scan. The parapharyngeal space was the most involved among deep neck spaces. Eight patients underwent abscess dissection including one case with dissection in one space and CT-guided percutaneous aspiration and drainage in another space. Three patients underwent tracheotomy simultaneously. Intravenous antibiotics was given all patients and nasogastric feeding in 5 patients. Hospital stay was(29.1 ±7.3) days. Totally 11 patients were cured and 1 patient died. Conclusions It is indicated in this study that early and adequate use of broad-spectrum antibiotics, timely drainage, airway management and nutritional support are the key to treat deep neck space infection comprehensively.
引文
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[16]Yuan H,Gao R.Infrahyoid involvement may be a highrisk factor in the management of non-odontogenic deep neck infection:Retrospective study[J].Am J Otolaryngol,2018,39(4):373-377.
[17]Sharma K,Das D,Joshi M,et al.Deep neck space infections-a study in diabetic population in a tertiary care centre[J].Indian J Otolaryngol Head Neck Surg,2018,70(1):22-27.
[18]Boscolo-Rizzo P,Stellin M,Muzzi E,et al.Deep neck infections:a study of 365 cases highlighting recommendations for management and treatment[J].Eur Arch Otorhinolaryngol,2012,269(4):1241-1249.
[19]Govea-Camacho LH,Astudillo-Carrera A,HermosilloSandoval JM,et al.Impact of vacuum-assisted closure management in deep neck abscesses[J].Cir Cir,2016,84(4):275-281.
[20]Hyun SY,Oh HK,Ryu JY,et al.Closed suction drainage for deep neck infections[J].J Craniomaxillofac Surg,2014,42(6):751-756.
[21]Adovica A,Veidere L,Ronis M,et al.Deep neck infections:review of 263 cases[J].Otolaryngol Pol,2017,71(5):37-42.
[22]Martin CA,Gabrillargues J,Louvrier C,et al.Contribution of CT scan and CT-guided aspiration in the management of retropharyngeal abscess in children based on a series of 18 cases[J].Eur Ann Otorhinolaryngol Head Neck Dis,2014,131(5):277-282.
[2]Hurley RH,Douglas CM,Montgomery J,et al.The hidden cost of deep neck space infections[J].Ann R Coll Surg Engl,2018,100(2):129-134.
[3]Gujrathi AB,Ambulgekar V,Kathait P.Deep neck space infection-A retrospective study of 270 cases at tertiary care center[J].World J Otorhinolaryngol Head Neck Surg,2016,2(4):208-213.
[4]Warshafsky D,Goldenberg D,Kanekar SG.Imaging anatomy of deep neck spaces[J].Otolaryngol Clin North Am,2012,45(6):1203-1221.
[5]Aslaner MA.Laryngopyocele:A deep neck infection diagnosed by emergency ultrasound[J].Am J Emerg Med,2018,36(11):2132.e5-2132.e7.
[6]Huang TT,Liu TC,Chen PR,et al.Deep neck infection:analysis of 185 cases[J].Head Neck,2004,26(10):854-860.
[7]Brito TP,Hazboun IM,Fernandes FL,et al.Deep neck abscesses:study of 101 cases[J].Braz J Otorhinolaryngol,2017,83(3):341-348.
[8]Das R,Nath G,Mishra A.Clinico-pathological profile of deep neck space infection:a prospective study[J].Indian J Otolaryngol Head Neck Surg,2017,69(3):282-290.
[9]Daramola OO,Flanagan CE,Maisel RH,et al.Diagnosis and treatment of deep neck space abscesses[J].Otolaryngol Head Neck Surg,2009,141(1):123-130.
[10]Lee YQ,Kanagalingam J.Deep neck abscesses:the Singapore experience[J].Eur Arch Otorhinolaryngol,2011,268(4):609-614.
[11]Hedge A,Mohan S,Lim WE.Infections of the deep neck spaces[J].Singapore Med J,2012,53(5):305-312.
[12]Russell MD,Russell MS.Urgent infections of the head and neck[J].Med Clin North Am,2018,102(6):1109-1120.
[13]Ban MJ,Jung JY,Kim JW,et al.A clinical prediction score to determine surgical drainage of deep neck infection:A retrospective case-control study[J].Int J Surg,2018,52:131-135.
[14]Park MJ,Kim JW,Kim Y,et al.Initial nutritional status and clinical outcomes in patients with deep neck infection[J].Clin Exp Otorhinolaryngol,2018,11(4):293-300.
[15]Cho SY,Woo JH,Kim YJ,et al.Airway management in patients with deep neck infections:A retrospective analysis[J].Medicine(Baltimore),2016,95(27):e4125.
[16]Yuan H,Gao R.Infrahyoid involvement may be a highrisk factor in the management of non-odontogenic deep neck infection:Retrospective study[J].Am J Otolaryngol,2018,39(4):373-377.
[17]Sharma K,Das D,Joshi M,et al.Deep neck space infections-a study in diabetic population in a tertiary care centre[J].Indian J Otolaryngol Head Neck Surg,2018,70(1):22-27.
[18]Boscolo-Rizzo P,Stellin M,Muzzi E,et al.Deep neck infections:a study of 365 cases highlighting recommendations for management and treatment[J].Eur Arch Otorhinolaryngol,2012,269(4):1241-1249.
[19]Govea-Camacho LH,Astudillo-Carrera A,HermosilloSandoval JM,et al.Impact of vacuum-assisted closure management in deep neck abscesses[J].Cir Cir,2016,84(4):275-281.
[20]Hyun SY,Oh HK,Ryu JY,et al.Closed suction drainage for deep neck infections[J].J Craniomaxillofac Surg,2014,42(6):751-756.
[21]Adovica A,Veidere L,Ronis M,et al.Deep neck infections:review of 263 cases[J].Otolaryngol Pol,2017,71(5):37-42.
[22]Martin CA,Gabrillargues J,Louvrier C,et al.Contribution of CT scan and CT-guided aspiration in the management of retropharyngeal abscess in children based on a series of 18 cases[J].Eur Ann Otorhinolaryngol Head Neck Dis,2014,131(5):277-282.