182例颈深部多间隙脓肿的回顾性分析

A retrospective analysis of deepneck multiple space abscesses in 182 patients

摘要:

目的回顾性分析与总结颈深部多间隙脓肿的临床诊治经验，以提高临床医生对本病的认识与诊疗水平。方法选取2008年3月～2018年3月于陆军军医大学第一附属医院就诊的颈深部多间隙脓肿182例患者，对其临床特点、相关检查、治疗及随访情况进行回顾性分析。结果182例患者中，男女患者数之比为1.98∶1，27例合并有全身系统性疾病，其中25例为糖尿病，1例高血压3级，1例慢性肾病2期。最常见的临床症状为颈部包块和颈部疼痛。下颌下间隙是最常累及的间隙，其次是咽旁间隙，牙源性和上呼吸道感染是最常见的致病原因。对所有患者的脓液进行细菌学培养，其中45例（24.7%）培养阳性，阳性结果中最常见的致病菌为链球菌属（43.6%）。在糖尿病患者中，4例细菌培养阳性，全为肺炎克雷伯杆菌。所有患者选用敏感抗生素治疗，其中152例患者行脓肿切开引流术；最常见并发症为气道阻塞，其中33例（18.1%）行气管切开术；有合并症患者给予对症处理。住院治疗2～43 d，151例患者获治愈，31例患者缓解，没有死亡病例。出院后随访1个月情况良好，感染无复发。结论颈深部多间隙脓肿男性患病率较女性高，起病急，进展迅速，脓肿切开引流和联合应用敏感抗生素仍然是本病的主要治疗方法。脓液细菌培养呈现出大量的阴性结果，因此细菌学培养仅仅作为使用抗生素的参考，气管切开仍然是保障术后安全的必要条件，对于减少并发症及改善预后起到了重要作用。治疗中要特别关注合并全身系统性疾病和老年患者并发症的处理。

关键词:颈部脓肿|气管切开|下颌下间隙|牙源性感染

Abstract:

ObjectiveTo review and summarize our clinical experience in the treatment of deepneck multiple space abscesses so as to improve the diagnosis and treatment level of this disease.MethodsClinical data of 182 patients suffering from deepneck multiple space abscesses treated in hospital between March 2008 and March 2018 were analyzed retrospectively. The analyzed data included the clinical characteristics, results of examinations, treatment and followup.ResultsIn the 182 patients, the maletofemale ratio was 1.98∶1. 27 patients were combined with underlying systemic diseases, including diabetes in 25, grade 3 hypertension in one and chronic nephropathy in another one. The most common symptoms were cervical masses and cervical pain. Submandibular space was the most commonly affected space, followed by parapharyngeal space. Odontogenic infection and upper respiratory tract infection were the most common causes. Bacterial culture of pus collected from all patients showed positive results in 45 cases with Streptococcus as the most common pathogen (43.6%). Of the 25 with diabetes, only 4 patients got positive culture result and were all affected by Klebsiella pneumoniae. Antibiotic therapy was applied to all patients and 152 received incision and drainage of abscesses. The most common complication was airway obstruction, and 33 patients (18.1%) received tracheotomy. After 2 to 43 days of hospitalization, the symptoms were cured in 151 or relieved in 31, and there was neither death nor recurrence.ConclusionsDeepneck multiple space abscesses affect a higher proportion of men than women. It is characterized by acute onset and rapid progress. Incision and drainage of abscesses and combined use of sensitive antibiotics remain the main treatment for this disease. The bacterial culture result is just for reference in the antibiotic therapy due to negativity in majority of our cases. Tracheotomy is vital to ensure postoperative safety, reduce complications and improve the prognosis. Special attention must be given to the treatment of underlying systemic diseases and complications in elderly patients during the management of deepneck multiple space abscesses.

Key words:Neck space abscess|Tracheotomy| Submandibular space| Odontogenic infection