通过自然沟通通道引流颈深部多间隙脓肿的疗效分析

Analysis of curative effect of drainage of deep cervical multi-space abscess through natural communication channels

摘要:

目的 探讨颈深部多间隙脓肿患者的临床特点，初步分析各间隙之间自然沟通通道引流的治疗效果。方法 回顾性分析17例颈深部多间隙脓肿患者的临床资料，患者在明确诊断后均行颈部开放引流术，术中通过颈深部各解剖间隙之间自然沟通通道置入半管引流，开放手术切口，加强抗感染及全身支持治疗，待术区分泌物消失拔除引流管，创面健康肉芽生长后二期关闭切口。结果 17例患者中，男13例，女4例；年龄28～76岁，平均年龄56.3岁。其中牙源性感染9例(52.9%)，咽喉部异物史3例(17.7%)，感染来源无法确定5例(29.4%)。脓肿位于舌骨上15例(88.2%)，同时合并舌骨下间隙脓肿5例(29.4%)，舌骨下间隙脓肿2例(11.8%)。脓肿累及下颌下间隙16例(94.1%)，累及咽旁隙13例(76.5%)，累及腮腺间隙2例(11.8%)，颞下间隙1例(5.9%)，翼颌间隙1例(5.9%)，脓肿经颈鞘达前上纵隔2例(11.8%)。细菌涂片、分泌物培养结果中，8例培养出细菌，其中肺炎克雷伯菌4例，产酸克雷伯菌1例，均为合并糖尿病患者；咽峡炎链球菌2例，大肠埃希菌1例。细菌涂片详情未知的革兰氏阳性球菌2例；培养结果未见细菌生长7例。1例累及腮腺间隙患者二次行腮腺脓肿切开引流术治愈。1例术后第6天颈部引流部位出血，局部压迫效果不佳，行介入右侧颈外动脉栓塞后治愈。1例合并下消化道肿瘤患者，住院期间急性下消化道出血死亡。其他患者均治愈出院。术后引流管拔除时间11～20 d，平均16.3 d；住院时间11～49 d，平均24.3 d。结论 通过开放颈深部各受累间隙之间的自然沟通通道引流，保证充分引流同时便于换药和观察感染控制情况，可以避免多处切开，结合敏感抗生素及营养支持治疗是治疗颈深部多间隙脓肿的有效方法。

Abstract:

Objective To investigate the clinical features of patients with deep cervical multi-space abscess, and to preliminarily analyze the therapeutic effect of abscess drainage through the natural communication channels between the anatomical spaces. Methods Clinical data of 17 patients with deep cervical multi-space abscess were retrospectively analyzed. All patients underwent open drainage surgery after diagnosis. During the operation, a semi-tube drainage was placed through the natural communication channels between the anatomical spaces in the neck, the surgical incision was opened, and anti-infection and systemic supportive treatments were strengthened. The drainage tube was removed after the secretions in the surgical area disappeared, and the incision was closed in the second phase after healthy granulation tissue grew on the wound. Results Among the 17 patients, 13 were male and 4 were female. The age ranged from 28 to 76 years, with an average age of 56.3 years. The causes of the disease included dental infection in 9 patients (52.9%), a history of foreign body in the pharynx in 3 (17.7%), and unascertainable source of infection in 5 cases (29.4%). The abscess was located in the suprhyoid area in 15 patients (88.2%) with simultaneous subhyoid space abscess in 5 of them (29.4%), and subhyoid space in 2 cases (11.8%). The abscess involved submandibular space in 16 patients (94.1%), parapharyngeal space in 13 patients (76.5%), parotid space in 2 patients (11.8%), subtemporal space in 1 patient (5.9%), pterygomaxillary space in 1 patient (5.9%). The abscess extended through the cervical sheath to the anterior superior mediastinum in 2 patients (11.8%). In the results of bacterial smear and secretion culture, bacteria were cultured in 8 patients, including 4 cases of Klebsiella pneumoniae and 1 case of Klebsiella acidogenes (all with diabetes), 2 cases of Streptococcus angina, and 1 case of Escherichia coli. There were 2 cases of Gram-positive cocci with unknown details of bacterial smear. No bacterial growth was observed in 7 cases. One patient with involvement of the parotid space was cured by incision and abscess drainage twice. One patient had bleeding at the neck drainage site on the sixth postoperative day, with local compression not effective, and was cured by right external carotid artery embolization. One patient with lower gastrointestinal tumor died of acute lower gastrointestinal hemorrhage during hospitalization. All the other patients were cured and discharged. The average time for removal of drainage tube was 11 to 20 days, with an average of 16.3 days.The duration of hospitalization ranged from 11 to 49 days, with an average of 24.3 days. Conclusion By opening the natural communication channels between the deep neck interspaces, abscess drainage is ensured to allow adequate drainage, facilitate dressing change and observation of infection control, and multiple incision can be avoided. Combining sensitive antibiotics and nutritional support, drainage through the natural communication channels is an effective method for the treatment of deep neck multi-space abscess.