摘要
目的:探讨颈部蜂窝织炎及合并纵隔胸腔脓肿患者的诊治方法与疗效。方法:颈部蜂窝织炎及合并纵隔胸腔脓肿患者共37例,所有患者均经超声、X线、CT、穿刺、微生物学等检查确诊。通过不同病情患者的保守治疗与外科处理的对比,分析此类患者的诊治策略。结果:23例患者因呼吸困难进行性加重行气管切开术,感染完全控制后均顺利拔管。9例炎症相对较轻者,给予抗感染等保守治疗后痊愈。21例单纯颈部多发脓腔切开清除坏死组织;7例颈部合并纵隔脓肿,其中伴中毒性休克2例,经颈部径路行颈部及上纵膈脓肿切开。所有病例均充分切开贯通脓腔、置管引流、反复冲洗、换药;伴脓胸的2例同时行胸腔闭式引流。所有患者均结合药敏试验给予敏感抗生素抗感染治疗、抗休克治疗、全身支持治疗及局部处理,均痊愈出院。其中保守治疗患者平均住院天数为15.7d,外科处理的患者平均住院天数为25.3d。结论:颈部蜂窝织炎病情轻重不一,少数轻症可通过保守治疗治愈。重者进展迅速,当合并纵隔胸腔脓肿时易导致严重并发症,外科处理风险大,充分切开脓肿、贯通脓腔、置管引流冲洗,结合敏感抗生素及支持治疗是治疗的关键。
Ojective：Explore the diagnosis,treatment and curative effect of cervical cellulitis combineing mediastinal pleural abscess.Method：Clinical data of 37 patients with the cervical cellulitis and mediastinal pleural abscess were analyzed,all patients were confirmed using ultrasond,X-ray,CT,puncture and microbiology examination.The result will analysis the diagnosis,treatment and curative effect through the comparison of conservative treatment and surgical treatment.Result：Twenty-three cases of patients were underwent tracheotomy because of difficulty in breathing and successfully extubated after treatment.Nine cases of patients were given anti-infection treatment and recovered after conservative treatment.Twenty-one cases of neck multiple pus cavity were underwent cavity incision,full removal of necrotic tissue and pipe flushing;7 cases of patients with neck and mediastinal abscess and within which 2 cases were with toxic shock were underwent adequate drainage of lavage and abscess incision through jugular joint path;the companion of pyothorax in 2 cases were underwent the chest closed drainage.All patients were giving sensitive antibiotic after drug sensitive test,anti-shock treatment and supportive treatment.All the patients were recovered and discharged.The average hospitalization days with conservative treatment of these patients were 15.7 days,and the average hospitalization days with surgical treatment of patients were 25.3 days.Conclusion：The condition of cervical cellulitis is complex,a few case can be cured with conservative treatment.The others progress rapidly when merging mediastinal pleural abscess can cause serious complications,surgical treatment is risky,fully abscess incision,lavage drainage and combine with sensitive antibiotics and supportive treatment are the keys to therapy.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
北大核心
2016年第6期468-470,473,共4页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
颈部蜂窝织炎
纵隔脓肿
脓胸
手术治疗
cervical cellulitis
mediastinal abscess
pyothorax
surgical treatment
