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。

Consideration on the treatment of severe and complex deep neck space infection

Objective The incidence of deep neck infection (DNI) has been increasing in recent years. Sometimes, the treatment of DNI is intractable. This study aims to improve the clinician''s understanding of this disease and the choice of treatment through the analysis of difficult cases with DNI.Methods Clinical data of 7 patients with severe and complex deep neck space infection admitted to our hospital from January 2018 to June 2022 were analyzed retrospectively.Results The 7 patients included 5 males and 2 females. Their age ranged from 40 to 72 years old, with an average age of 56.86 and 5 were over 50. Diabetes mellitus (4 cases) was the most common comorbidities. The most frequently involved neck space was the parapharyngeal space (6 cases), followed by the submandibular space (5 cases) and the pretracheal space (5 cases). All patients were managed with surgical treatment and antibiotics. Five cases underwent lateral cervical incision and drainage with combining cervicothoracic incision and drainage in 2, 1 underwent intraoral incision and drainage, 1 received percutaneous mediastinal puncture drainage.Tracheotomy was performed in one case. All the patients were cured. The most common complication was hypoproteinemia (4 cases), followed by descending necrotizing mediastinitis (3 cases).Conclusions Complicated deep neck space infection tends to occur in elderly men and patients with diabetes. Early diagnosis and prompt treatment play critical roles in reducing serious complications. Individualized treatment strategy can help to shorten the course of infection in different space.