广泛性颈部坏死性筋膜炎(附2例报告)

目的：探讨广泛性颈部坏死性筋膜炎的病因、临床特征、诊断和治疗,提高对这一罕见急重症的认识。方法：分析2例广泛性颈部坏死性筋膜炎患者的临床资料,结合文献,总结颈部坏死性筋膜炎的病因、临床表现和诊治经验。结果：2例患者,1例为下咽异物引起,1例原因不明。临床特征性表现：颈部红肿及颈深部多处脓肿形成,皮下捻发感,表情淡漠,细菌培养均为混合感染。经足量广谱抗生素、输血和白蛋白等支持疗法和局部多处切开引流、彻底清创和气管切开等外科处理,2例患者均获痊愈。结论：广泛性颈部坏死性筋膜炎病情凶险,病死率高,诊断主要根据临床表现、颈部体征和影像学检查。及时有效的外科处理是治疗成功的关键。     

29例颈部坏死性筋膜炎临床分析

目的：探讨颈部坏死性筋膜炎的临床特点及治疗经验。方法：29例颈部坏死性筋膜炎患者均经CT检查确诊,其中12例行气管切开并行颈侧切开排脓探查术,另17例仅行颈侧切开排脓探查术,术中颈部脓肿切开引流,术后冲洗换药并进行抗感染治疗。结果：28例患者治愈出院,1例死亡。其中有2例并发颈内静脉血栓,4例并发纵隔感染,后经治疗后痊愈。随访半年无复发病例。结论：颈部坏死性筋膜炎患者确诊后应尽早采取手术探查,行颈部脓肿切开引流治疗,可获得满意疗效,并有助于预防严重并发症。     

颈部坏死性筋膜炎6例

目的：提高临床医师对颈部坏死性筋膜炎的认识。方法：回顾分析6例颈部坏死 性筋膜炎患者的临床资料及治疗结果。结果：6例患者经手术及药物治疗,5例治愈,1例因并发脓毒血症导致多器官功能衰竭死亡。结论：颈部坏死性筋膜炎 是一种进展迅速、病情凶险的感染性疾病,治疗上以尽早彻底清创、应用广谱抗菌素及支持治疗为主,增加对该病的认识有利于早期诊断,并有利于提高颈部坏死性筋膜炎的疗效。     

颈部坏死性筋膜炎7例并文献复习

目的 探讨颈部坏死性筋膜炎的临床特点及治疗经验。 方法 7例颈部坏死性筋膜炎患者均经颈部CT及术中所见确诊,其中行气管切开并行颈部切开引流术(其中1例为外院施行)2例,另仅行颈部切开引流术5例,术后冲洗换药并进行抗感染治疗。 结果 治愈6例,随访半年无复发;死亡1例。 结论 颈部坏死性筋膜炎患者确诊后应尽早采取手术探查,行颈部脓肿切开引流治疗,可获得满意疗效,并有助于预防严重并发症。     

颈部坏死性筋膜炎1例并文献复习

<正>坏死性筋膜炎(necrotizing fasciitis,NF)是一种进展迅速、病情凶险、致死性的软组织感染,多发于腹部、会阴及四肢,颈部较为罕见[1]。2013年5月我科诊治颈部坏死性筋膜炎1例,现结合文献对其进行分析,以增加对本病的认识、提高治疗成功率。1资料与方法1.1一般资料患者男,45岁,因"咽痛2 d,气促1 d"入院。2 d前因咽痛就诊,拟诊"急性咽炎"予口服抗生素治疗,症状无缓解,1 d前咽痛加重、自觉气促急诊入院。入院查体:T36.2℃,P80次/min,HR12次/min,BP125/86 mmHg。左侧扁桃体周围     

颈部坏死性筋膜炎并粒细胞减少一例报告

正1病历资料患者女,33岁,无明显诱因出现右侧颈前区肿痛5 d,既往有甲亢病史5年余,规律口服甲巯咪唑片(10 mg,tid),半年前开始停药,近1个月复查甲功病情复发,遂继续口服甲巯咪唑片(10 mg,tid),无高血压、糖尿病等病史。症状有右侧颈前区肿胀、疼痛,少许瘙痒,无吞咽、呼吸困难,无张口受限,无咽痛、咽异物感,无发热。查体示:T:36.5℃,P 98     

颈部坏死性筋膜炎诊治的回顾性分析

目的探讨颈部坏死性筋膜炎（cervical necrotizing fasciitis,CNF）的病因、诊断和治疗,从而提高外科医生对坏死性筋膜炎的认知度。方法回顾性分析上海交通大学医学院附属仁济医院耳鼻咽喉科2011年1月～2017年12月收治的临床资料完整的颈部坏死性筋膜炎患者16例,所有患者在入院后接受紧急手术,其中10例患者接受了1次清创手术,6例患者接受了两次以上的清创手术,10例患者进行了气管切开术。结果16例患者经手术及药物治疗均痊愈。其中3例合并糖尿病患者并发下行坏死性纵隔炎,经颈部清创术联合胸腔镜手术及药物治疗均痊愈;10例进行了气管切开术的患者出院前气管套管均拔除,均无气管狭窄等并发症。所有患者平均住院时间32 d,出院后随访3个月,无复发,情况良好。结论颈部坏死性筋膜炎是病情凶险、发展迅速、死亡率较高的颈部感染性疾病,早期诊断、彻底清创、联合应用敏感抗生素及配合全身支持治疗是诊治的关键所在。     

细菌产气与颈部坏死性筋膜炎相关性研究

目的 比较颈部坏死性筋膜炎与其他颈部间隙感染疾病影像学检查积气征情况,探讨感染细菌产气与颈部坏死性筋膜炎的相关性。方法 回顾性分析52例颈部筋膜间隙感染患者病历资料,其中颈部坏死性筋膜炎18例,均行切开清创置管引流术;非坏死性筋膜炎性颈部感染34例,行切开清创置管引流术26例,行超声引导下穿刺活检并置管引流术8例。两组患者均于术中或术后多次取脓性分泌物送细菌培养和药敏试验,所有患者术前均行颈部CT或MRI检查,并排除前期手术切开或穿刺史及颈部间隙感染已破溃情况。结果 18例颈部坏死性筋膜炎患者中15例(83.3%)影像学检查有筋膜间隙积气征,34例非坏死性筋膜炎性颈部间隙感染患者中2例(5.9%)有筋膜间隙积气征,两组比较差异有统计学意义(χ²=32.084 2,P<0.01)。坏死性筋膜炎组中14例(77.8%)患者的细菌培养结果阳性,其中混合感染5例、链球菌13例、肺炎克雷白菌4例、金黄色葡萄球菌1例、铜绿假单胞菌1例、鲍曼不动杆菌1例;非坏死性筋膜炎组中12例(35.3%)患者细菌培养结果阳性,其中链球菌4例、肺炎克雷伯菌2例、金黄色葡萄球菌1例,凝固...     

以急性会厌炎为首诊的3例颈部坏死性筋膜炎病例报告并文献复习

目的 探讨急性会厌炎与颈部坏死性筋膜炎的相关性及治疗经验.方法 回顾性分析3例以急性会厌炎为首诊的颈部坏死性筋膜炎患者的临床资料,对急性会厌炎与颈部坏死性筋膜炎间的相关性及诊治经过进行分析.结果 3例患者经颈部CT明确诊断后均行手术治疗,1例死亡,2例治愈出院.结论 对于以急性会厌炎为首诊经积极抗感染抗炎治疗无效的患者...     

颈部坏死性筋膜炎1例

坏死性筋膜炎(necrotizing fasciitis,NF)主要特征是皮肤、皮下组织及广泛筋膜坏死而不累及感染部位的肌肉,是一种少见的突发性、致死性软组织感染[1].常见部位胸部、腹部、腹股沟、会阴及四肢,颈部血供丰富,故发生于颈部者少见[2].颈部坏死性筋膜炎(cervical necrotizing fasciitis,CNF)多由口腔及咽喉疾病引起,起病急、进展快、病情凶险,其最大特点是感染可沿颈部筋膜板迅速向下蔓延,极易并发纵隔炎,在短时间内致死[3,4].我院今年6月成功救治l例重症CNF患者,现报道如下.     

Cervical necrotizing fasciitis

Necrotizing fasciitis is a severe soft tissue infection that results in necrosis of the fasciae and subcutaneous tissues; the infection can quickly prove fatal. Although involvement of the head and neck is rare, causes are usually odontogenic or pharyngeal but can also be insect bites, local trauma, burns or surgery. We present a clinical case of a 31-year-old Italian woman with cervical necrotizing fasciitis having an uncommon presentation. While under treatment, the patient’s husband was admitted for necrotizing fasciitis of the medial fasciae of his left leg subsequent to an insect sting. The causes, diagnosis and treatment of necrotizing fasciitis are reviewed. Received: 3 August 1998 / Accepted: 12 January 1999     

Management of facial necrotizing fasciitis

Necrotizing fasciitis is a progressive, life-threatening, bacterial infection of the skin, the subcutaneous tissue and the underlying fascia, in most cases caused by ß-hemolytic group A streptococcus. Only early diagnosis and aggressive therapy including broad spectrum antibiotics and surgical intervention can avoid systemic toxicity with a high mortality rate. This uncommon disease generally occurs in the lower extremities and trunk, and only rarely affects the head and neck region. When located in the face necrotizing fasciitis is associated with severe cosmetic and functional restrictions due to the invasive infection and often to the necessary surgical treatment. Generally surgical intervention cannot be performed in the face as aggressively as in the extremities and trunk, since a lot of vital structures are found in a relatively small area. In the following article, we present the successful diagnostic and therapeutic management of an isolated facial necrotizing fasciitis as a consequence of a nasal bone fracture with a minor dermal cut.     

咽周坏死性筋膜炎1例

<正>坏死性筋膜炎(Necrotizing fasciitis,NF)是一种软组织感染,其临床特征为扩展迅速、病情凶险、具有极强破坏性,好发于免疫力低下的老年人,多原发于腹部及四肢,扁桃体周围脓肿引起者极为少见[1]。2010年10月21日,我院收入咽周坏死性筋膜炎患者1例,现将诊疗病历资料报告如下。1资料与方法1.1一般资料患者女,62岁,以"反复右侧咽痛2     

A fatal case of craniofacial necrotizing fasciitis

A case of fatal craniofacial necrotizing fasciitis is described in a 72-year-old diabetic woman and management is discussed. Progressive infection of the eyelids occured with involvement of the right side of the face. Computed tomography revealed soft tissue swelling. Antibiotic treatment was started and debridement performed; histopathology showed acute inflammation and thrombosis of the epidermis and dermis. Despite treatment, scepticemia occurred, resulting in death less than 48 h after presentation. At this time extensive necrosis had developed in the superficial fascia with undermining and gangrene of surrounding tissues. Streptococcus and Staphylococcus were the pathogens involved. Poor prognosis in similar patients has been associated with extensive infection, involvement of the lower face and neck, delayed treatment, advanced age, diabetes and vascular disease. Received: 26 August 1998 / Accepted: 4 December 1998     

坏死性颈筋膜炎的临床诊治进展

坏死性颈筋膜炎是由细菌混合感染引起的颈部严重软组织炎症,以颈部皮下组织和深浅筋膜坏死为特征,易感人群以老年人及合并慢性基础疾病(如糖尿病)者为主。临床上早期诊断率较低,病情进展迅速,易出现危及生命的并发症,如下行坏死性纵隔炎、脓毒性休克等,病死率极高。就坏死性颈筋膜炎的临床诊治做综述,为更好对其早期诊断及治疗提供帮助。