颈深部脓肿50例临床分析

目的探讨颈深部脓肿患者的临床表现、微生物学、影像学及治疗经验。方法对1997年1月—2002年12月收治的50例颈深部脓肿患者的临床资料进行了回顾性分析。结果颈深部脓肿的感染来源有：牙源性3例，急性化脓性扁桃体炎及喉炎8例，上呼吸道感染9例，咽喉及食道异物14例，糖尿病伴感染5例，不明原因11例。50例中21例作了脓液细菌培养，其中13例(64％)为阳性。通过采用脓肿切开引流术，经颈一纵隔引流术，大剂量抗生素等综合治疗，50例中治愈46例(92％)，死亡4例(8％)。死亡原因：2例为咽旁脓肿致颈部大血管破裂出血死亡，1例食道周围脓肿伴消化道大出血死亡，1例咽旁脓肿合并糖尿病中毒性休克死亡。结论颈深部脓肿一经确诊，应及时引流，合理应用抗生素，有效控制其他伴发病。重视对严重并发症的认识及处理，以提高治愈率。     

咽后脓肿临床诊治分析

目的探讨咽后脓肿的临床表现及治疗方法。方法对31例咽后脓肿的临床资料进行回顾分析。18例（58.1%）继发于咽异物损伤,7例（22.6%）继发于急性化脓性扁桃体炎及喉炎,4例（12.9%）继发于上呼吸道感染,2例（6.5%）原因不明。全部病例行颈部X线平片检查,表现为咽后肿胀型7例,液平型13例,液气型11例。其中9例发现喉咽异物残留。27例经口行咽后脓肿切开＋置管引流,4例保守治疗。结果 28例治愈,3例并发纵膈脓肿及肺脓肿感染性休克死亡。结论咽异物损伤是咽后脓肿的主要诱因。颈部X线片分型对诊断及治疗预后有重要价值。经口咽后脓肿切开＋置管引流是一有效治疗方法。应重视对严重并发症的早期认识及处理。     

儿童咽后脓肿48例临床诊治分析

目的总结儿童咽后脓肿的临床特点、诊断及治疗方法。方法回顾性分析深圳市儿童医院2003年7月～2011年5月收治的咽后脓肿患儿的临床症状、治疗方法及预后。结果 48例患儿入院后均行脓肿切开排脓术,术后常规应用抗生素治疗,患儿全部治愈出院。结论咽后壁脓肿患儿有颈部活动受限,特别是不能后仰,部分患儿可发生呼吸困难或喉喘鸣;CT扫描对诊断咽后脓肿有重要价值;如确认脓腔形成,则应行脓肿切开排脓术。     

咽后脓肿14例临床回顾

目的：探讨咽后脓肿的临床特点，提高对该病的诊治水平。方法：直接喉镜引导下经口行咽后脓肿切开引流术，术后辅以全身抗炎治疗。结果：13例痊愈，1例放弃治疗，自动出院，无严重并发症发生。结论：对咽后脓肿应做到早期诊断。全身应用有效抗生素，及时切开引流，以提高治愈率，减少并发症的出现。     

咽旁脓肿引发下行性坏死性纵隔炎1例

颈部及牙原性感染引起的急性纵隔感染又称下行性坏死性纵隔炎(descending necrotizingmediastintis,DNM),临床上罕见,如诊断不及时、未及时经颈或经胸引流,可能会导致死亡.2010年1月,我们采用咽旁脓肿切开、经颈纵隔引流和B超引导下颈部多脓肿穿刺抽脓的联合治疗方法,治愈咽旁脓肿引发DNM患者1例,报告如下.     

穿刺吸脓治疗小儿咽后脓肿16例

穿刺吸脓治疗小儿咽后脓肿１６例司鸿章１小儿咽后脓肿为咽后隙淋巴结的急性化脓性炎症，以往多切开排脓配合全身应用抗生素治疗。我科１９８０～１９９５年采用穿刺吸脓治疗小儿咽后脓肿１６例，取得较好疗效，总结报告如下。１临床资料１６例中，男９例，女７例，年龄...     

颈深部感染临床分析及相关因素探讨

目的:探讨颈深部感染的临床特点,提高对该病的诊治水平。方法:回顾性分析我科2003-01-2012-04收治的45例颈深部感染患者的临床资料。45例患者均采用大剂量抗生素全身治疗,26例患者经CT检查确定脓肿形成,采用脓肿切开引流术联合抗生素治疗。结果:19例未形成脓肿的患者经全身大剂量抗生素治疗后均获治愈出院;26例患者经脓肿切开引流术联合抗生素治疗后治愈出院,无并发症发生。结论:对颈深部感染做到早期诊断、早期治疗非常重要;颈深部脓肿一经确诊,及时行脓肿切开引流术,合理应用抗生素,有效控制感染及并发症的发生,加强营养支持治疗可提高治愈率。     

儿童急性中耳炎并发耳后骨膜下脓肿的临床分析

目的 分析儿童急性中耳炎并发耳后骨膜下脓肿的临床特点和治疗方案。方法 回顾性分析2010年9月—2020年8月住院治疗的9例急性中耳炎并发耳后骨膜下脓肿患儿的临床资料，分析可能的致病原因、致病菌和治疗措施。结果 9例患儿发病前均有上呼吸道感染史，出现耳部症状至入院治疗病程2～3周。2例鼓膜完整患儿采用乳突切开并鼓膜切开置管术，另7例鼓膜穿孔溢脓患儿采用脓肿切开引流及每日换药。脓液细菌培养示肺炎链球菌5例，咽峡链球菌2例，2例未见细菌生长。术后住院7～10 d，耳后肿胀消退，外耳道流脓停止。随访12～18个月，9例患儿均未见复发，疗效均满意。结论 儿童急性中耳炎并发耳后骨膜下脓肿，治疗方法以脓肿切开引流或乳突切开术为主，辅以静滴抗生素，绝大部分预后良好。     

牙源性感染并发纵隔炎

牙源性感染向下蔓延并发纵隔炎(MS)者少见。作者报告5例,结合复习文献并介绍经颈部作纵隔脓肿引流的技术。本文5例中男4,女1。年龄19～51岁。有牙痛或拔牙后数日发生颈胸部肿胀、中毒性症状或呼吸困难。经X线片及CT检查确诊,行颈部切开进入MS排脓置管引流,并作气管切开及用抗生素治疗,结果3例治愈,2例死亡。     

以脑病症状为首发表现的儿童颈深部脓肿一例

本文报道首都儿科研究所附属儿童医院收治的1例颈深部脓肿患儿的诊疗经过。患儿女,2岁,家长诉“睡眠增多5 d,头痛伴发热4 d”,初诊于神经内科,后经专科查体及影像学检查确诊为颈深部脓肿后转入耳鼻喉科治疗。予经咽后壁脓肿穿刺引流手术联合敏感抗生素抗感染治疗后患儿痊愈出院。儿童颈深部感染有时早期临床表现不典型,易漏诊或误诊...     

Parapharyngeal abscess: diagnosis and treatment

To study the circumstances of diagnosis, predisposing factors, bacteriology and therapeutic management of parapharyngeal abscesses. This retrospective study over a period of 7 years concerned 16 patients hospitalized in an ENT and Head and Neck surgery department for parapharyngeal abscess. All patients were treated by intravenous antibiotics and steroids for 5–7 days. The length of hospital stay was 6–15 days. Parapharyngeal abscesses associated with peritonsillar and retropharyngeal abscess were all initially aspirated transorally for evacuation and bacteriologic examination. Five patients underwent surgical drainage (two via cervical incision, three by immediate tonsillectomy techniques and one by intra-oral drainage). Two patients presented jugular vein thrombosis. No life-threatening complication was observed. Patients were considered to be cured when cervical CT scan performed on D21-45 was normal. Parapharyngeal abscess is the second most common deep neck abscess after peritonsillar abscess. The diagnosis is both clinical and radiologic. CT scan is the best imaging examination for diagnosis and follow-up of parapharyngeal abscess. Non-complicated parapharyngeal abscesses require first-line medical management (intravenous antibiotics (amoxicillin and clavulanic acid) combined with steroids) and follow-up CT scan.     

Contribution of CT scan and CT-guided aspiration in the management of retropharyngeal abscess in children based on a series of 18 cases

ObjectiveThis study was designed to analyse the contribution of CT scan to the management of retropharyngeal abscess in children and the place of CT-guided percutaneous aspiration as an alternative to surgical drainage.Materials and methodsRetrospective study including 18 children with a mean age of 38 months [range: 5–67 months] presenting with retropharyngeal infection between 2006 and 2011. All cases were initially assessed by contrast-enhanced CT scan of the neck. Clinical, radiological treatment and bacteriological data were collected. Radiological results were correlated with surgical and percutaneous aspiration findings (presence or absence of an abscess).ResultsThe initial CT scan detected 14 abscesses, 3 cases of non-suppurative lymphadenitis and one case of retropharyngeal oedema. One case of non-suppurative lymphadenitis progressed to abscess after failure of antibiotic therapy and was treated surgically. Surgical drainage revealed a purulent collection in 11 cases and no collection in 3 cases. Four CT-guided percutaneous aspirations were successfully performed. Three cases were treated by antibiotics alone (2 cases of lymphadenitis and 1 case of retropharyngeal oedema). Bacteriological examinations revealed the presence of Streptococcus pyogenes in 78.5% of cases. The positive predictive value of the initial CT scan was 78.8% in our series.ConclusionContrast-enhanced neck CT scan confirmed the diagnosis of retropharyngeal abscess and the indication for surgical drainage. It must be performed urgently, on admission. When it is decided to treat the patient with antibiotics alone, follow-up imaging should be performed in the absence of improvement 24 to 48 hours after starting antibiotics. CT-guided percutaneous aspiration is both a diagnostic modality confirming abscess formation of an inflammatory lesion of the retropharyngeal space as well as a therapeutic tool, sometimes avoiding the need for surgical drainage.     

小儿咽后脓肿14例临床分析

报告14例小儿咽后脓肿,急性型13例,慢性型1例;异物性2例,结核性1例,邻近炎症扩散引起者2例,上呼吸道感染所致9例;14例颈侧位X线片示脓肿2例,10例颈部CT扫描示脓肿7例.所有病例经脓液引流及抗炎或抗痨治疗后痊愈.     

Deep Neck Infections in Children: A New Approach to Diagnosis and Treatment

Forty-seven children presented with the diagnosis of a deep neck infection-either cellulitis or abscess-between January 1991 and July 1996. Forty-four (94%) had contrast-enhanced computed tomography (CT) imaging consistent with this diagnosis. Three patients with no CT scan had confirmation of an abscess at surgical drainage. Parenteral antibiotics alone were effective in the treatment of 24 of 47 infections (51%): seven parapharyngeal, one retropharyngeal, and 16 combined. By CT scan these infections represented cellulitis in 17 of 24 (71%), an abscess in three of 24 (13%), and incomplete abscess in four of 24 (17%). The average duration of hospitalization for this group was 4.8 days, with symptomatic improvement usually seen within 24 hours. Surgical drainage was performed on 23 of 47 infections (49%): three parapharyngeal, 17 combined, and three of unknown specific location. In 22 of these 23 children (96%), transoral drainage of the abscess was used as the primary surgical approach. In 21 of these 22 (95%) there was complete resolution without complications or recurrence; one abscess required a subsequent external approach. CT scanning with contrast revealed that all deep neck infections were located medial (usually anteromedial) to the great vessels. Abscesses with volumes estimated to be greater than 2000 mm³ were more likely to undergo surgery, but these differences were not statistically significant. The use of contrast-enhanced CT scanning provides information regarding abscess size, location, and relative position of the great vessels for safe and successful transoral drainage. Thus we recommend CT-assisted transoral drainage for combined retropharyngeal/parapharyngeal abscesses and selected isolated parapharyngeal abscesses that do not respond to parenteral antibiotics.     

Correlation between computed tomography and surgical findings in retropharyngeal inflammatory processes in children.

Retropharyngeal abscess (RPA) in children is a potentially life-threatening process which often requires immediate surgical intervention. Contrast enhanced computed tomography (CT) is utilized frequently to determine abscess versus cellulitis/phlegmon and aids in determining cases needing surgical drainage. The purpose of this retrospective study was to determine the accuracy of CT in distinguishing retropharyngeal abscess from cellulitis in children. The medical records of 32 children from 1989 to 1997 suspected of having a retropharyngeal abscess were reviewed. All patients included in the study underwent a CT scan as well as surgical exploration within 48 h of the scan. Two patients required two surgical procedures (n = 34). A comparison between CT results and operative findings was made to determine the accuracy of CT imaging in confirming the presence of RPA versus cellulitis. Suspected diagnosis of abscess or cellulitis/phlegmon on CT was confirmed at surgery in 25 of 34 cases (73.5%). The false positive rate of CT scan was 11.8% (4/34), while the false negative rate was 14.7% (5/34). Based on our results, CT is accurate in differentiating abscess from cellulitis in 73.5% of cases. Clinical findings, as well as radiologic findings, must be considered together prior to surgical drainage of a suspected retropharyngeal abscess in children.     

Retropharyngeal abscess: report of 2 cases

Retropharyngeal abscesses are uncommon and their frequency has decreased since the development of antibiotics. It is important to recognize this serious condition in order to begin treatment promptly. The causes of these processes differ in children and adults, as do the symptoms of presentation. Lateral cervical radiography and CT are diagnostic in only a few cases. Treatment is abscess drainage. Two cases of retropharyngeal abscess are reported. The first case occurred in a child and was due to infection of Waldeyer's lymphatic ring. The second occurred in an adult as a result of foreign body trauma.     

Cases presenting as parotid abscesses in children

BACKGROUND: A parotid abscess is a rare complication of acute suppurative parotitis which most often requires hospitalization, intravenous antibiotic therapy, and surgical drainage. OBJECTIVE: To investigate the clinical picture, treatment, and prognosis of children with a parotid abscess in a search for optional clinical guidelines for treatment. METHODS: A retrospective chart review was performed for 10 children (age相似文献   

Peritonsillar abscess with parapharyngeal and retropharyngeal involvement: incidence and intraoral approach

CONCLUSION: This study illustrates common sites of infection seen in peritonsillar abscesses with involvement of the pharyngeal space and retropharyngeal space. Abscesses behind and/or inferior to the tonsil were encountered more frequently than expected. In these cases, the drainage had to be placed in the inferior pole of the tonsil and these types were frequently seen in older patients. OBJECTIVES: The aim of this study was to assess to what extent abscesses spread in patients with peritonsillar abscess and to determine to what extent pus can be drained intraorally. PATIENTS AND METHODS: The clinical charts of 45 patients with peritonsillar abscess involvement of the parapharyngeal space and/or retropharyngeal space were retrospectively reviewed. RESULTS: In 45 cases, 21 patients were diagnosed with the superior type, and we could drain the pus intraorally in 90% of the patients. On the other hand, 24 cases were diagnosed with the inferior type and they were drained intraorally in 58% of the cases.     

Retropharyngeal abscesses in children revisited

Retropharyngeal abscess appears in infancy and early childhood. Because of the advances in antibiotic therapy, the frequency of this disease has decreased considerably. If overlooked, however, the sequelae of retropharyngeal abscess can be disastrous. Of the typical signs and symptoms listed in presentation, the swelling of the posterior pharyngeal wall is referred to as an important diagnostic sign. This presentation will discuss the fallibility of this important sign in the evaluation of a retropharyngeal abscess in children. The size of the pediatric oral cavity and the presence of pooling secretions in the pharynx, due to retropharyngeal tissue swelling, make assessment of swelling of the posterior pharyngeal wall extremely difficult. Radiological assessment of retropharyngeal abscesses cannot differentiate between cellulitis and abscess formation. The presentation will discuss the radiological appearance of a retropharyngeal swelling and discuss the differentiation of abscess formation from cellulitis. The rationale for a therapeutic regime will be developed to validate the concept that with suggestive clinical signs, suggestive radiological diagnosis, and in spite of negative evidence of retropharyngeal swelling by oral examination, justification exists for an examination under anesthesia and incision and/or aspiration of the retropharyngeal abscess.