颈深部脓肿患者的临床治疗及效果分析

吴俊; 周兰柱; 孙哲; 王文忠

doi:10.16766/j.cnki.issn.1674-4152.002589

颈深部脓肿患者的临床治疗及效果分析

doi: 10.16766/j.cnki.issn.1674-4152.002589

蚌埠医学院第一附属医院耳鼻咽喉头颈外科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学研究重点项目 KJ2020A0590

安徽省高校自然科学研究重点项目 KJ2020A0568

详细信息

通讯作者:
王文忠, E-mail: 13955259093@163.com

中图分类号: R632.5
计量
- 文章访问数: 353
- HTML全文浏览量: 207
- PDF下载量: 9
- 被引次数: 0
出版历程
- 收稿日期: 2022-01-13

Clinical treatment and effect analysis of patients with deep neck abscess: 3 special cases

Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨颈深部脓肿患者的临床表现和治疗情况，总结治疗经验，以期降低并发症，提高治疗水平。方法回顾性选择2018年1月—2021年10月蚌埠医学院第一附属医院耳鼻咽喉头颈外科治疗的22例颈部脓肿患者的临床资料，其中男性17例、女性5例。入院后积极予以广谱抗生素治疗或者手术治疗，观察患者临床特征、诊疗方法及效果。结果 12例行颈侧切开脓肿引流，其中1例同时行胸腔镜胸腔脓肿清除；1例患者术前颈部CT及三维CT显示为扁桃体异物伴脓肿，行扁桃体切除术+咽部异物探查术，见扁桃体周脓性分泌物，未见异物，好转后出院观察；1例患者术前颈部CT显示为颈部异物伴咽后脓肿，本例插管困难，紧急行气管切开术，后行咽后脓肿切开引流+异物探查+食道镜探查，见大量脓液未见明显异物，好转后出院观察; 4例B超下穿刺持续引流，其中1例引流效果不佳并发脓毒血症放弃治疗；1例颈总动脉假性动脉瘤破裂后行修补；其余3例保守治疗。出院后随访1个月，除放弃治疗1例外其余21例均治愈且无复发。结论颈深部脓肿是耳鼻咽喉头颈外科的危急重症之一，术前诊断和紧急切开引流是治疗关键，诊断时应结合多种检查防止漏诊、误诊，必要时可行造影检查。呼吸困难者选择气管切开，全麻麻醉插管评估，合理使用抗生素，密切关注全身情况等在治疗中起到重要作用。
- 颈深部脓肿 /
- 早期诊断 /
- 切开引流 /
- 手术方法 /
- 治疗效果
Abstract: Objective To investigate the clinical manifestations and treatment of patients with deep neck abscess, and to summarize the treatment experience, in order to reduce complications and improve the level of treatment. Methods Retrospective analysis of the clinical data from 22 patients with neck abscess in the Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Bengbu Medical College, collected from January 2018 to October 2021, among which, 17 were male and 5 were female. After admission, patients actively treated with broad-spectrum antibiotics or surgical treatment, meanwhile, the patient ' s clinical characteristics, diagnosis and treatment methods and effects were recorded. Results Twelve cases underwent lateral neck incision and abscess drainage, of which 1 case underwent thoracoscopic thoracic abscess removal at the same time; 1 case showed a tonsillar foreign body with abscess on neck CT and three-dimensional CT before operation, and underwent tonsillectomy as well as pharyngeal foreign body exploration. There was a peritonsilar purulent secretion, and no foreign body was found, then, the patient was discharged for observation after recovery; 1 case showed a cervical foreign body with a retropharyngeal abscess on neck CT, before the operation. Further, intubation was difficult, and an emergency tracheotomy was performed in this case. Subsequently, postpharyngeal abscess incision and drainage, foreign body exploration, as well as esophagoscopy exploration were applied, and a large amount of pus was found, no obvious foreign body was discovered, then the patient was discharged for observation after recovery; 4 cases of continuous drainage under B-ultrasound puncture, among which, 1 case of poor drainage and complicated by sepsis, and the treatment was given up; 1 case of common carotid artery pseudoaneurysm was repaired after rupture; the remaining 3 cases were treated conservatively. After being discharged from the hospital, the patients were followed up for 1 month. Except for the 1 case who gave up the treatment, the remaining 21 cases were cured without recurrence. Conclusion Deep neck abscess is one of the critical illnesses in otolaryngology head and neck surgery. Preoperative diagnosis and emergency incision and drainage are the key to treatment. Diagnosis should be combined with a variety of examinations to prevent missed diagnosis or misdiagnosis, and angiographic examination can be performed if necessary. Patients with dyspnea choose tracheotomy, general anesthesia intubation assessment, rational use of antibiotics, and close attention to the general condition, which play an important role in the treatment.
- Deep neck abscess /
- Early diagnosis /
- Incision and drainage /
- Surgical methods /
- Therapeutic effect
利益冲突 无

HTML全文

参考文献(27)

[1]	陈兴龙, 胡纯红. 颈部脓肿合并下行性坏死纵隔炎的诊断和治疗策略[J]. 实用心脑肺血管病杂志, 2020, 28(S2): 4-8. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL2020S2002.htm CHEN X L, HU C H. Diagnosis and treatment strategies for neck abscess with descending necrotizing mediastinitis[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2020, 28(S2): 4-8. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL2020S2002.htm
[2]	郑宏雨, 李紫璇, 牛志兴, 等. 口腔颌面部及颈部多间隙感染合并下行性坏死性纵隔炎多学科协作诊疗的回顾性分析[J]. 中华口腔医学杂志, 2020, 55(12): 952-957. doi: 10.3760/cma.j.cn112144-20200217-00062 ZHENG H Y, LI Z X, NIU X Z, et al. Retrospective analysis of the effectiveness of treating multi-space infection combined with descending necrotizing mediastinitis at oral maxillofacial and cervical region via multidisciplinary team collaboration[J]. Chinese Journal of Stomatology, 2020, 55(12): 952-957. doi: 10.3760/cma.j.cn112144-20200217-00062
[3]	MA C, ZHOU L, ZHAO J Z, et al. Multidisciplinary treatment of deep neck infection associated with descending necrotizing mediastinitis: A single-centre experience[J]. J Int Med Res, 2019, 47(12): 6027-6040. doi: 10.1177/0300060519879308
[4]	蒋威, 金鑫. 颌面颈部多间隙感染危险因素及不同方案治疗效果分析[J]. 陕西医学杂志, 2019, 48(12): 1660-1662, 1666. doi: 10.3969/j.issn.1000-7377.2019.12.022 JIANG W, JIN X. Risk factors of maxillofacial and cervical multispace infection and effect analysis of different treatment schemes[J]. Shaanxi Medical Journal, 2019, 48(12): 1660-1662, 1666. doi: 10.3969/j.issn.1000-7377.2019.12.022
[5]	骆小华, 靳娟霞, 王朝永, 等. 颈深部多间隙脓肿23例临床分析[J]. 中国耳鼻咽喉头颈外科, 2021, 28(2): 105-108. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT202102011.htm LUO X H, JIN J X, WANG C Y, et al. Clinical analysis of 23 cases of multiple deep neck abscess[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2021, 28(2): 105-108. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT202102011.htm
[6]	OTANI H, NOTSU M, KOIKE S, et al. Acute suppurative thyroiditis caused by thyroid papillary carcinoma in the right thyroid lobe of a healthy woman[J]. Thyroid Res, 2018, 15(11): 4.
[7]	陈鹏, 刘冰, 魏博, 等. 老年口腔颌面颈部多间隙感染的诊治分析[J]. 中华老年口腔医学杂志, 2021, 19(3): 145-148. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHKQ202103004.htm CHEN P, LIU B, WEI B, et al. Diagnosis and treatment of oral maxillofacial and neck multi space infection in the elderly[J]. Chinese Journal of Geriatric Dentistry, 2021, 19(3): 145-148. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHKQ202103004.htm
[8]	ALEGBELEYE B J. Deep neck infection and descending mediastinitis as lethal complications of dentoalveolar infection: Two rare case reports[J]. J Med Case Rep, 2018, 12(1): 195. doi: 10.1186/s13256-018-1724-x
[9]	陈国平, 潘忠, 叶飞, 等. 12例颈深部并下行性纵隔感染患者的诊断和治疗[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(4): 324-327. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202104009.htm CHEN G P, PAN Z, YE F, et al. Diagnosis and treatment of 12 patients with deep neck infection and inferior mediastinal infection[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2021, 35(4): 324-327. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202104009.htm
[10]	O'BRIEN K J, SNAPP K R, DUGAN A J, et al. Risk factors affecting length of stay in patients with deep neck space infection[J]. Laryngoscope, 2020, 130(9): 2133-2137. doi: 10.1002/lary.28367
[11]	WEI D, BI L, ZHU H Y, et al. Less invasive management of deep neck infection and descending necrotizing mediastinitis: A single-center retrospective study[J]. Medicine (Baltimore), 2017, 96(15): e6590. DOI: 10.1097/MD.0000000000006590.
[12]	欧阳怿鹏. 负压封闭引流技术联合药物冲洗治疗颌面颈部间隙感染的临床效果[J]. 临床合理用药杂志, 2021, 14(12): 154-156. https://www.cnki.com.cn/Article/CJFDTOTAL-PLHY202112058.htm OUYANG Y P. Clinical effect of negative pressure sealing drainage combined with drug irrigation in the treatment of maxillofacial and cervical space infection[J]. Chinese Journal of Clinical Rational Drug Use, 2021, 14(12): 154-156. https://www.cnki.com.cn/Article/CJFDTOTAL-PLHY202112058.htm
[13]	许雯, 汤玮, 余少卿, 等. 颈部CT、超声与MRI对颈深部脓肿诊断价值的对比研究[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(7): 672-674. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201907024.htm XV W, TANG W, YU S Q, et al. Deep neck space infections diagnosis: a comparison between neck CT, ultrasound and MRI[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2019, 33(7): 672-674. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201907024.htm
[14]	周兰柱, 周恩晖, 刘素茹, 等. 颈部坏死性筋膜炎的临床特点及处理策略[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(6): 545-548. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201906019.htm ZHOU L Z, ZHOU E H, LIU S R, et al. Clinical characteristics and management of cervical necrotizing fasciitis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2019, 33(6): 545-548. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201906019.htm
[15]	KAUR R, SINGH P, KAUR N, et al. Role of computed tomography (CT) in localisation and characterisation of suprahyoid neck masses[J]. Pol J Radiol, 2017, 82: 263-270.
[16]	曹武, 黄志纯, 冯立人, 等. 颈深部多间隙脓肿34例临床分析[J]. 中国耳鼻咽喉头颈外科, 2020, 27(5): 282-285. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT202005013.htm CAO W, HUANG Z C, FENG L R, et al. Multi-space deep neck abscess: analysis of 34 cases[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2020, 27(5): 282-285. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT202005013.htm
[17]	徐建慧, 叶飞, 傅敏仪, 等. 82例颈深部感染诊治分析[J]. 中国耳鼻咽喉头颈外科, 2019, 26(11): 589-591. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT201911006.htm XU J H, YE F, FU M Y, et al. Deep neck infection: clinical analysis of 82 cases[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2019, 26(11): 589-591. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT201911006.htm
[18]	曾大顺, 陈剑云, 喻棣, 等. B超引导下经皮穿刺引流在颌面颈部间隙感染的应用[J]. 医学研究杂志, 2019, 48(7): 121-124, 39. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYZ201907030.htm ZENG D S, CHEN J Y, YU L, et al. Application of percutaneous puncture in maxillofacial and cervical space infection with the guide of B-mode ultrasound[J]. Journal of Medical Research, 2019, 48(7): 121-124, 39. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYZ201907030.htm
[19]	朱志超, 杨旭, 郑峰, 等. 颈部双平行切口联合纵隔镜或胸腔镜治疗颈部坏死性筋膜炎伴下行性坏死性纵隔炎的临床初探[J]. 中华口腔医学杂志, 2019, 54(5): 309-314. ZHU Z C, YANG X, ZHENG F, et al. Clinical study of cervical necrotizing fasciitis accompanied with descending necrotizing mediastinitis treated with cervical double parallel incision combined with mediastinoscope or thoracoscope[J]. Chinese Journal of Stomatology, 2019, 54(5): 309-314.
[20]	王科, 彭国光, 何善志, 等. 负压封闭引流术治疗牙源性颌面-颈部-纵隔感染5例临床分析[J]. 口腔疾病防治, 2020, 28(9): 581-585. WANG K, PENG G G, HE S Z, et al. Clinical analysis of 5 cases of odontogenic maxillofacial-neck-mediastinal infection treated with negative pressure sealing drainage[J]. Journal of Dental Prevention & Treatment, 2020, 28(9): 581-585.
[21]	贾军, 张楠楠, 王永良, 等. 颈深部多间隙感染的临床特征及治疗[J]. 中国民康医学, 2017, 29(23): 103-105. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMYX201723047.htm JIA J, ZHANG N N, WANG Y L, et al. Clinical characteristics and treatment of deep cervical multispace infection[J]. Medical Journal of Chinese People's Health, 2017, 29(23): 103-105. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMYX201723047.htm
[22]	CHEN S L, CHIN S C, WANG Y, et al. Factors Affecting patients with concurrent deep neck infection and cervical necrotizing fasciitis[J]. Diagnostics (Basel), 2022, 12(2): 443.
[23]	ALMUTAIRI D M, ALQAHTANI R M, ALSHAREEF N, et al. Deep neck space infections: A retrospective study of 183 cases at a tertiary hospital[J]. Cureus, 2020, 12(2): e6841. DOI: 10.7759/cureus.6841.
[24]	PESIS M, BAR-DROMA E, ILGIYAEV A, et al. Deep neck infections are life threatening infections of dental origin: A presentation and management of selected cases[J]. Isr Med Assoc J, 2019, 12(21): 806-811.
[25]	GALLO O, MANNELLI G, LAZIO M S, et al. How to avoid life-threatening complications following head and neck space infections: An algorithm-based approach to apply during times of emergency. When and why to hospitalise a neck infection patient[J]. J Laryngol Otol, 2018, 132(1): 53-59.
[26]	洪艺云, 林功标, 林昶, 等. 成人咽旁(咽后)间隙脓肿临床危险因素分析[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(17): 1304-1308. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201817004.htm HONG Y Y, LIN G B, LIN C, et al. Adult parapharyngeal and retropharyngeal abscesses: Clinical features and their implications for treatment strategy[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(17): 1304-1308. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201817004.htm
[27]	施明美, 郭普. 血液感染病原菌的分布特点及其耐药性的分析研究[J]. 中华全科医学, 2021, 19(9): 1542-1544. doi: 10.16766/j.cnki.issn.1674-4152.002107 SHI M M, GUO P. Analysis of the distribution characteristics and drug resistance of pathogenic bacteria of blood infection[J]. Chinese Journal of General Practice, 2021, 19(9): 1542-1544. doi: 10.16766/j.cnki.issn.1674-4152.002107