颈部坏死性筋膜炎7例并文献复习

目的 探讨颈部坏死性筋膜炎的临床特点及治疗经验。 方法 7例颈部坏死性筋膜炎患者均经颈部CT及术中所见确诊,其中行气管切开并行颈部切开引流术(其中1例为外院施行)2例,另仅行颈部切开引流术5例,术后冲洗换药并进行抗感染治疗。 结果 治愈6例,随访半年无复发;死亡1例。 结论 颈部坏死性筋膜炎患者确诊后应尽早采取手术探查,行颈部脓肿切开引流治疗,可获得满意疗效,并有助于预防严重并发症。     

细菌产气与颈部坏死性筋膜炎相关性研究

目的 比较颈部坏死性筋膜炎与其他颈部间隙感染疾病影像学检查积气征情况,探讨感染细菌产气与颈部坏死性筋膜炎的相关性。方法 回顾性分析52例颈部筋膜间隙感染患者病历资料,其中颈部坏死性筋膜炎18例,均行切开清创置管引流术;非坏死性筋膜炎性颈部感染34例,行切开清创置管引流术26例,行超声引导下穿刺活检并置管引流术8例。两组患者均于术中或术后多次取脓性分泌物送细菌培养和药敏试验,所有患者术前均行颈部CT或MRI检查,并排除前期手术切开或穿刺史及颈部间隙感染已破溃情况。结果 18例颈部坏死性筋膜炎患者中15例(83.3%)影像学检查有筋膜间隙积气征,34例非坏死性筋膜炎性颈部间隙感染患者中2例(5.9%)有筋膜间隙积气征,两组比较差异有统计学意义(χ²=32.084 2,P<0.01)。坏死性筋膜炎组中14例(77.8%)患者的细菌培养结果阳性,其中混合感染5例、链球菌13例、肺炎克雷白菌4例、金黄色葡萄球菌1例、铜绿假单胞菌1例、鲍曼不动杆菌1例;非坏死性筋膜炎组中12例(35.3%)患者细菌培养结果阳性,其中链球菌4例、肺炎克雷伯菌2例、金黄色葡萄球菌1例,凝固...     

食管异物并发食管穿孔及颈部脓肿临床分析

目的：探讨食管异物并发食管穿孑L及颈部脓肿的临床特点及治疗方法,以期提高对该病的诊治水平。方法：24例食管异物并发食管穿孔及颈部脓肿患者均在全身麻醉下行食管镜检查异物取出术,其中经食管镜取出异物14例,开胸后取出义齿3例,颈侧切开取出异物5例;余2例未见异物。结果：24例患者中并发脓肿16例,其中食管周围脓肿10例,颈部脓肿4例,纵隔脓肿2例;治愈21例,死亡1例,1例因血糖高转内分泌科,1例转胸外科继续治疗。结论：早期诊断、早期治疗是处理食管异物并发食管穿孔的关键。对于食管异物并发食管穿孔及颈部脓肿患者行薄层CT扫描具有极高的诊断及鉴别诊断价值。颈部脓肿一经确诊,应及时行脓肿切开引流术,合理应用抗生素,有效控制感染及并发症的发生,加强营养支持治疗可提高治愈率。     

以急性会厌炎为首诊的3例颈部坏死性筋膜炎病例报告并文献复习

目的 探讨急性会厌炎与颈部坏死性筋膜炎的相关性及治疗经验。 方法 回顾性分析3例以急性会厌炎为首诊的颈部坏死性筋膜炎患者的临床资料,对急性会厌炎与颈部坏死性筋膜炎间的相关性及诊治经过进行分析。 结果 3例患者经颈部CT明确诊断后均行手术治疗,1例死亡,2例治愈出院。 结论 对于以急性会厌炎为首诊经积极抗感染抗炎治疗无效的患者应警惕颈部坏死性筋膜炎的可能。积极抗感染治疗、及时局部切开引流,并重视全身基础疾病的治疗是颈部坏死性筋膜炎治疗的关键。     

牙源性感染并发纵隔炎

牙源性感染向下蔓延并发纵隔炎(MS)者少见。作者报告5例,结合复习文献并介绍经颈部作纵隔脓肿引流的技术。本文5例中男4,女1。年龄19～51岁。有牙痛或拔牙后数日发生颈胸部肿胀、中毒性症状或呼吸困难。经X线片及CT检查确诊,行颈部切开进入MS排脓置管引流,并作气管切开及用抗生素治疗,结果3例治愈,2例死亡。     

广泛性颈部坏死性筋膜炎(附2例报告)

目的：探讨广泛性颈部坏死性筋膜炎的病因、临床特征、诊断和治疗,提高对这一罕见急重症的认识。方法：分析2例广泛性颈部坏死性筋膜炎患者的临床资料,结合文献,总结颈部坏死性筋膜炎的病因、临床表现和诊治经验。结果：2例患者,1例为下咽异物引起,1例原因不明。临床特征性表现：颈部红肿及颈深部多处脓肿形成,皮下捻发感,表情淡漠,细菌培养均为混合感染。经足量广谱抗生素、输血和白蛋白等支持疗法和局部多处切开引流、彻底清创和气管切开等外科处理,2例患者均获痊愈。结论：广泛性颈部坏死性筋膜炎病情凶险,病死率高,诊断主要根据临床表现、颈部体征和影像学检查。及时有效的外科处理是治疗成功的关键。     

颈侧切开术在颈段食管异物取出中的应用

目的探讨颈侧切开术治疗颈段食管异物的适应证和临床诊疗要点。方法回顾性分析2001年1月～2011年3月行颈侧切开术治疗25例颈段食管异物患者临床资料。25例患者中21例发生食管穿孔,其中食管穿孔并发颈部脓肿18例,3例为贯穿性异物未并发颈部脓肿;嵌顿性颈段食管异物4例。结果 25例患者均经颈侧切开手术治疗后痊愈出院。3例患者出现声音嘶哑,2例患者半年内恢复,1例未恢复。2例气管切开者均在住院期间拔除气管套管。结论颈段食管异物穿孔并颈部脓肿形成和贯穿性异物和嵌顿性异物经食管镜未能取出者应为颈侧切开术良好适应证。     

颈部坏死性筋膜炎6例

目的：提高临床医师对颈部坏死性筋膜炎的认识。方法：回顾分析6例颈部坏死 性筋膜炎患者的临床资料及治疗结果。结果：6例患者经手术及药物治疗,5例治愈,1例因并发脓毒血症导致多器官功能衰竭死亡。结论：颈部坏死性筋膜炎 是一种进展迅速、病情凶险的感染性疾病,治疗上以尽早彻底清创、应用广谱抗菌素及支持治疗为主,增加对该病的认识有利于早期诊断,并有利于提高颈部坏死性筋膜炎的疗效。     

头颈外科

诊断和鉴别诊断。治疗以手术彻底切除为宜。参4(原提要)950引4化脓性纵隔炎的手术治疗13例报告/张玉梅…了临床耳鼻咽喉科杂志一1994,8 (3)。一]79 一3例中男一x例,女2例;年龄r7一73岁。脓肿发生于后上纵隔12例,前和后纵隔1例。慢性中耳乳突炎急性发作并发侧窦周围积脓所致颈深脓肿后上纵隔炎2例,病程7一25天。局麻下行颈侧径路纵隔切开引流n例,其中2例合并行乳突凿开术引流病灶根治,颈中线径路切开前和后上纵隔合并气管h]]开1例;胸腔闭式引流未做纵隔切开1例。疗效:治愈12例,死于中毒性心肌炎1例。(袁文).50引1颈侧非金属异物长期误诊误治…     

颈部坏死性筋膜炎诊治的回顾性分析

目的探讨颈部坏死性筋膜炎（cervical necrotizing fasciitis,CNF）的病因、诊断和治疗，从而提高外科医生对坏死性筋膜炎的认知度。方法回顾性分析上海交通大学医学院附属仁济医院耳鼻咽喉科2011年1月～2017年12月收治的临床资料完整的颈部坏死性筋膜炎患者16例，所有患者在入院后接受紧急手术，其中10例患者接受了1次清创手术，6例患者接受了两次以上的清创手术，10例患者进行了气管切开术。结果16例患者经手术及药物治疗均痊愈。其中3例合并糖尿病患者并发下行坏死性纵隔炎，经颈部清创术联合胸腔镜手术及药物治疗均痊愈；10例进行了气管切开术的患者出院前气管套管均拔除，均无气管狭窄等并发症。所有患者平均住院时间32 d，出院后随访3个月，无复发，情况良好。结论颈部坏死性筋膜炎是病情凶险、发展迅速、死亡率较高的颈部感染性疾病，早期诊断、彻底清创、联合应用敏感抗生素及配合全身支持治疗是诊治的关键所在。     

头颈部坏死性筋膜炎7例临床分析

目的：探讨头颈部坏死性筋膜炎的病因、临床表现、诊断和治疗，加强对这一罕见疾病的认识。方法：回顾分析1992-2002年10年收治的7例头颈部坏死性筋膜炎的病例资料并复习文献。结果：7例全部行积极的内科保守治疗和外科处理（包括局部切开引流、清创术和气管切开术），其中2例死亡。结论：临床上对该病应有足够的认识，以期早期诊断。及时有效的外科处理是治疗成功的关键。     

Descending necrotizing mediastinitis: ten years' experience

Descending necrotizing mediastinitis is a rare disease that is usually caused by a spreading, diffuse inflammatory reaction (phlegmon) to an odontogenic infection or peritonsillar abscess. Reported mortality rates range from 25 to 40%. The use of antibiotics and advances in resuscitation procedures and critical care techniques have not essentially improved survival, and an effective treatment has not been clearly established. We report the findings of our 10-year study of 21 patients affected by phlegmon and/or fasciitis of the neck. The aim of our contribution is to help define the clinical criteria and diagnostic procedures that will improve the early diagnosis of mediastinal sepsis secondary to neck fasciitis and to suggest optimal treatment approaches. Our experience indicates that (1) cervical drainage alone is sufficient for cases of cervical phlegmon or mediastinal involvement that are limited to a single superior mediastinal space and (2) thoracotomy and drainage of mediastinal collections is necessary when mediastinal sepsis is more extensive.     

Necrotizing fasciitis as a lethal complication of peritonsillar abscess

Abscesses of the peritonsillar region rarely lead to serious complications. Incision and drainage, antibiotic therapy, and subsequent tonsillectomy is the accepted method of treatment. Two cases of fatal necrotizing fasciitis following peritonsillar abscess are presented. The entity of necrotizing fasciitis in the head and neck is discussed with respect to its presentation, diagnosis, and treatment.     

Diagnosis and treatment of necrotizing fasciitis of the head and neck region

BACKGROUND: Necrotizing fasciitis of the head and neck is a rare occurrence. It spreads rapidly along fascial planes causing extensive necrosis; it often results in gangrene of the overlying skin. Mostly involved are immunodeficient patients with banal infections of the upper aerodigestive tract, small traumas, but also after surgical procedures. The "Federal Health Agency" of the Federal Republic of Germany estimates a number of 40 cases a year in Germany for all regions of the body. The mortality is about 20%-50% dependent on the localisation of this soft tissue infection. PATIENTS: Four cases of necrotizing fasciitis of the head and neck region, which were treated at the ENT-Department of the Martin Luther University Halle-Wittenberg since 1995, were described. RESULTS: Despite aggressive surgical debridement and intensive care medicine two patients died because of streptococcus-associated-toxic-shock-syndrome. In all patients we found a diabetes mellitus as a known risk factor for this necrotizing soft tissue disease. In two of four patients with cervical involvement mediastinitis was diagnosed as a complication. The CT-scan showed this mediastinal spread only in one case. CONCLUSIONS: Only rapid diagnosis and surgical treatment with radical debridement can influence the disease positively. Thoracal CT-scan is necessary in all cases of cervical necrotizing fasciitis because of the high risk of mediastinal involvement. A strong complication is a streptococcus-associated-toxic-shock-syndrome, which should be prevented because it is often associated with a lethal outcome. Penicillin G and clindamycin are advocated for antibiotic treatment.     

严重和复杂颈深部间隙感染治疗的思考

目的 近年来颈深部间隙感染的发生率有增加的趋势,有时治疗十分棘手,本文通过复杂病例的分析以提高临床医生对本病的再认识和治疗选择。方法 回顾分析2018年1月—2022年6月收治的7例严重和复杂颈深部间隙感染患者的临床资料。结果 7例患者中男5例,女2例;年龄40~72岁,平均年龄56.86岁,其中大于50岁5例,小于50岁2例。4例患者合并糖尿病,感染部位以咽旁隙（6例）多见,其次是下颌下间隙（5例）和气管前间隙（5例）。所有患者均接受手术和抗生素治疗,其中5例颈侧切开包括2例颈胸联合切开引流,1例口内切开引流,1例经皮纵隔穿刺引流,1例气管切开。所有患者均治愈。最常见并发症是低蛋白血症（4例）,其次是下行坏死性纵隔炎（3例）。结论 复杂颈深部间隙感染多见于老年男性和糖尿病患者,早期诊断和及时治疗是减少严重并发症的关键,针对不同部位的感染,采用个体化治疗有助于缩短病程。     

Cervical necrotizing fasciitis: Report of 6 cases and review of literature

ObjectiveNecrotizing fasciitis in the cervical region is a rare entity, characterized by a fulminant infection that causes extensive necrosis of the subcutaneous tissue and fascial planes, with high mortality and morbidity rates. The origin is generally odontogenic or pharyngeal, involving a mixed flora of microorganisms. Descending infection and mediastinal involvement are usually associated and are the main complications. The aim of the present study was to review the cases treated in our department and analyze diagnosis and treatment, supplementing the understanding of the disease.MethodsA retrospective study was performed on the clinical records of patients admitted to our center between January 2005 and June 2010 with diagnosis of necrotizing cervical fasciitis.ResultsSix clinical records were reviewed. The origin of the infection was mainly oropharyngeal and odontogenic, with a mixed flora of Prevotella, Peptostreptococcus and coagulase-negative Staphylococcus. All patients presented mediastinal involvement: superior mediastinitis in 4 patients and superior and postero-inferior mediastinitis in 2 cases. All patients underwent early drainage by bilateral cervicotomy with mediastinal drainage by a cervical approach in those with superior mediastinal affection, and associated thoracotomy, in a single surgical step, for postero-inferior mediastinitis. Temporary tracheotomy was performed in all cases. All received broad spectrum antibiotics, with a medium hospital stay of 37 days. There were no deaths reported.ConclusionConcerning cervical necrotizing fasciitis, early diagnosis and surgical treatment associated to antibiotics and intensive medical care are essential to obtain a favorable outcome.