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
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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
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