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Title: [Clinical analysis of 27 cases with descending necrotizing mediastinitis].
Author: Zhang JL, Chen WX, Li JJ, He FY, Tang SC.
Journal: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi; 2019 Dec 07; 54(12):919-923. PubMed ID: 31887818.
Abstract:
Objective: To explore the clinical manifestation and treatment strategy for descending necrotizing mediastinitis (DNM). Methods: A total of 27 cases diagnosed as DNM from January 2010 to August 2018 in the First People's Hospital of Foshan were reviewed. There were 16 males and 11 females, age ranged from 16 to 84 years. The clinical data were collected. SPSS 16.0 software and chi square test were used for statistical analysis. Results: ALL 27 cases were diagnosed as DNM by contrast-enhanced CT scan of the neck and chest. Among the 27 cases, 13 cases resulted from peritonsillar abscess, 8 cases from esophageal foreign body perforation, 5 cases from parapharyngeal and retropharyngeal space abscess, and one case from infection of oral cavity. These 27 cases were divided into three subtypes according to the sites of mediastinitis, including 11 cases for typeⅠ, 5 cases for type ⅡA and 11 cases for type ⅡB. Of 27 cases, 20 cases underwent transcervical drainage for DNM, of which 5 cases with tracheotomy and 6 cases with thoracic drainage, and finally 19 of the 20 patients were cured, and one patient died of bacteremia; 7 cases refused to received surgery and were routinely treated with antibiotics, of which, one case was cured and 6 cases died. The curative rate in patients underwent surgery was significantly higher than that in patients treated with medication (χ(2)=13.638, P<0.001). Among the 20 cured cases, 4 cases were combined with diabetes mellitus and 6 cases with necrotizing fasciitis, while in the 7 died cases, 5 cases were combined with diabetes mellitus and 6 cases with necrotizing fasciitis. The comorbidity rates of diabetes mellitus (χ(2)=4.074, P=0.044) and necrotizing fasciitis (χ(2)=4.457, P=0.035) in died cases were significantly higher than those in cured cases. Conclusion: DNM is a serious infection, with high mortality especially in patients with diabetes and necrotizing fasciitis. Timely cervical and chest enhanced CT scan play vital role in its diagnosis. DNM can be treated effectively with transcervical drainage. 目的： 探讨下行坏死性纵隔炎（descending necrotizing mediastinitis，DNM）的临床特点及诊断治疗方法。 方法： 回顾分析2010年1月至2018年8月在佛山市第一人民医院耳鼻咽喉头颈外科诊治的27例DNM患者的临床资料，其中男16例，女11例，年龄16~84岁，总结患者病程规律、影像学检查特点，治疗方式及预后。使用SPSS 16.0软件，计数资料采用χ(2)检验进行统计学分析。 结果： 本组患者均行颈胸部CT增强扫描确诊为DNM。27例患者中，感染源于扁桃体周脓肿者13例，源于食管异物穿孔并脓肿形成者8例，源于咽旁间隙及咽后间隙脓肿者5例，源于口腔感染及脓肿者1例；根据下行性纵隔脓肿的部位进行分型，Ⅰ型者11例，ⅡA型者5例，ⅡB型者11例。所有患者中，20例接受经颈部纵隔脓肿清创引流术（手术组），同期有5例行气管切开术，6例行胸腔积液引流术，19例治愈出院，1例死亡；7例拒绝手术行抗菌药物抗感染治疗（非手术组），仅1例感染得到有效控制治愈出院，6例死亡。手术组治愈率明显高于非手术组，差异有统计学意义（χ(2)=13.638，P<0.001）。治愈的20例患者中，4例合并糖尿病，6例合并坏死性筋膜炎；死亡的7例患者中，5例合并糖尿病，6例合并坏死性筋膜炎，治愈患者中合并糖尿病（χ(2)=4.074，P=0.044）、坏死性筋膜炎（χ(2)=4.457，P=0.035）的比例均显著低于死亡患者中相应比例。 结论： DNM为危重感染性疾病，起病凶险、病死率高，及时行颈胸部CT增强扫描是诊断的关键，尽早行经颈部纵隔脓肿清创引流术可有效控制感染，合并糖尿病及坏死性筋膜炎可能是患者死亡的危险因素。.

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