41例颈深部间隙感染临床分析

Clinical analysis of deep-neck space infections in 41 patients

摘要:

目的探讨颈深部间隙感染的临床特征、治疗方式及疗效，总结临床治疗经验，提高疾病认识水平。方法回顾性分析2017年7月—2020年11月就诊于山西医科大学第一医院耳鼻咽喉头颈外科的41例颈深部间隙感染患者的临床资料。41例患者中，男28例，女13例；年龄8~85岁，平均年龄50岁。16例(39.0%)患者有明确的发病原因，最常见的发病诱因是先天性鳃裂囊肿和牙源性感染。最常见的临床症状是颈部疼痛、咽痛和发热；10例(24.4%)为单一间隙感染，31例患者为多间隙感染；最常累及的间隙是咽旁隙。结果33例患者行颈部脓肿切开引流术，其中4例患者同时行气管切开术；3例患者经B超引导下行颈部脓肿穿刺引流术；5例患者予以保守治疗。24例患者脓液培养为阳性，其中4例患者为多种微生物混合感染，最常见的是链球菌属，病程中根据脓液培养鉴定+药敏结果选用敏感抗生素治疗。15例患者出现术后并发症，经积极治疗均可缓解。41例患者经上述治疗均得到满意疗效，随访感染无复发。结论颈深部间隙感染仍是耳鼻咽喉头颈外科的危急重症，若及时正确处理, 预后良好, 否则可致严重并发症, 危及生命。颈部脓肿切开引流术仍是重要的治疗方法。

Abstract:

ObjectiveTo investigate the clinical characteristics, treatment and efficacy of deep cervical space infection, summarize the clinical treatment experience, and improve the level of disease awareness.MethodsIt was retrospectively analyzed that the clinical data of 41 patients with deep cervical space infection were treated in the department of Otolaryngology-Head and neck Surgery, the First Hospital of Shanxi Medical University from July 2017 to November 2020.There were 41 patients, including 28 males and 13 females, with age from 8 to 85 years old. and the average age was 50 years old. The causes were clear in 16 patients (39.0%), and the most common causes were congenital branchial cleft cyst and odontogenic infection. The most common clinical symptoms are neck pain, sore throat and fever. Ten cases with space infection were 24.4 %(10/41). Thirty-one patients had multiple interstitial infections. The most frequently infections were involved interstitial space being parapharyngeal space.ResultsThirty-three patients received incision and drainage for neck abscess. Four patients of them underwent simultaneous tracheotomy. Three patients received puncture and drainage for neck abscess guided by B-ultrasound. Five patients were treated conservatively. The pus culture of 24 patients was positive, among which 4 patients were infected with a variety of mixed microorganisms, the most common of which was Streptococcus. Sensitive antibiotics were selected for treatment according to the result of pus culture identification and drug sensitivity during the course of disease. Postoperative complications occurred in 15 patients. The complications of these patients could be alleviated by active treatment. All the 41 patients obtained satisfactory curative effect after the above treatment, and no recurrence of infection during follow-up.ConclusionDeep-neck space infection is still a critical and severe disease in Otolaryngology, Head and Neck Surgery. If treated correctly and promptly, the prognosis is good. Otherwise, it can lead to serious complications and threaten life.Cervical abscess incision and drainage is still an important treatment.