头颈外科

20050564颈深部脓肿50例临床分析/郑艳…//中华耳鼻咽喉科杂志·2005,40(1)·60~63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3例(64%)为阳性。通过采用脓肿切开引流术,经颈纵隔引流术,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…     

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。     

颈深部脓肿37例

目的探讨治疗颈深部脓肿的有效方法。方法对37例颈深部脓肿患者资料进行回顾性分析。结果本组所有患者经及时抢救治疗,术后随访6～12个月,全部治愈,无意外及并发症发生。结论颈深部脓肿一经确诊,及时行脓肿切开引流术,合理足量应用抗生素,有效控制感染及并发症的发生,加强营养支持治疗以提高治愈率。     

负压引流联合灌洗治疗颈部脓肿35例临床分析

目的探讨颈部脓肿的发病原因、临床表现、微生物学和治疗经验。方法对2010年2月~2016年3月收治的35例颈深部脓肿患者的临床资料进行了回顾性分析。结果 35例患者的感染来源为急性扁桃体炎14例,急性咽喉炎10例,牙源性感染2例,第三鳃裂瘘管伴感染1例,不明原因的8例;糖尿病伴感染12例;35例患者中27例做了脓液细菌培养,18例(66.7%)阳性;所有患者均行颈部脓肿切开负压引流、置管冲洗及合理应用抗生素等综合治疗后痊愈。结论颈深部脓肿一经确诊,应尽早切开引流,负压封闭引流联合灌洗治疗颈深部脓肿是一种安全方便、有效的方法。     

颈深部多发性脓肿伴咽瘘2例临床分析

目的探讨颈深多发性脓肿伴咽瘘的临床特点及治疗方法,以提高诊治水平。方法对我院2009年收治的2例颈深部多发性脓肿伴咽瘘的患者的临床资料进行回顾性分析。结果2例患者经抗感染、脓肿切开引流和局部换药治疗痊愈。结论颈深部脓肿合并喉咽瘘者鼻饲饮食和选择即时切开引流是治愈成功的关键。     

颈性下行性纵隔脓肿15例分析

目的 回顾性总结颈性下行性纵家肿的诊断与治疗经验。方法 分析１９８５年１月～１９９７年１２月收治的１５例颈性下行性纵隔脓肿的资料。结果 颈性下行性纵隔脓肿的原因有，牙源性，急性扁桃体炎引起咽旁脓中的资料，急性扁桃体炎引起咽旁中、胆脂瘤型中耳炎并发Ｍｏｕｒｅｔ脓肿各２例，咽异物擦伤６例，食管穿孔３例。咽或食管内纵隔引流６例次，颈－纵隔引流９例次，开胸引流２例次，其中１例广泛引流。治愈１２例，死亡３例     

颈深部筋膜间隙感染诊治体会

目的　探讨颈深部筋膜间隙感染的临床表现和诊断治疗方法。方法　回顾性分析2012年1月～2014年8月我院耳鼻咽喉头颈外科收治的105例颈深部间隙感染患者的临床资料,总结其发病特征和诊治策略。结果　105例颈深部间隙感染患者中,70例行脓肿切开引流,4例行脓肿穿刺抽液,31例行静脉抗生素消炎治疗,仅2例颈深部多筋膜间隙感染患者分别并发呼吸困难、纵隔感染,所有患者均治愈出院。结论　颈深部筋膜间隙感染一经确诊脓肿形成,应及时切开引流,根据药敏试验结果选用合适抗生素,控制基础疾病及严重并发症。     

41例颈深部间隙感染临床分析

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。     

B超引导下穿刺引流治疗糖尿病患者颈深部脓肿

颈深部感染是指颈深筋膜浅层深面的组织感染,常继发于头、面、颈部和上呼吸道,也可为全身性感染.此种感染不仅位置深,引起感染的原发病灶(如牙、咽、扁桃体、唾液腺、食管、呼吸道等)的位置也较深,及时正确地诊断和处理可预防颈深部脓肿的形成.糖尿病患者由于免疫功能低下,更易发生感染.2003年7月～2007年3月我院收治9例糖尿病并颈深部脓肿患者,行B超下穿刺引流,效果良好,现报道如下.     

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...     

Deep neck infections

Deep neck infection is relatively rare but potentially life threatening complication of common oropharyngeal infections. This retrospective study was aimed at analyzing the occurrence of complications, diagnostic methods and proper management of deep neck infection. A review was conducted in 32 cases who were diagnosed as having deep neck infection from 1995 to 2005. The causes of deep neck infections were tonsillitis (16 cases), tooth diseases (6 cases), paratonsillar abscess (4 cases), parotitis (1 case), pussy lymphonodes after tonsillectomy (2 cases), pussy congenital neck cyst (1 case), chronic otitis media (1 case), parotitis (1 case), foreign body of the esophagus (1 case). All the puss bacterial cultivation were positive. All the patients were treated by different ways of chirurgical drainage and use of large dosage of antibiotics. Deep neck infection should be suspected in patients with long lasting fever and painful swelling of the neck and treatment should begin quick as possible.     

食管异物并发食管穿孔及颈部脓肿临床分析

目的：探讨食管异物并发食管穿孑L及颈部脓肿的临床特点及治疗方法,以期提高对该病的诊治水平。方法：24例食管异物并发食管穿孔及颈部脓肿患者均在全身麻醉下行食管镜检查异物取出术,其中经食管镜取出异物14例,开胸后取出义齿3例,颈侧切开取出异物5例;余2例未见异物。结果：24例患者中并发脓肿16例,其中食管周围脓肿10例,颈部脓肿4例,纵隔脓肿2例;治愈21例,死亡1例,1例因血糖高转内分泌科,1例转胸外科继续治疗。结论：早期诊断、早期治疗是处理食管异物并发食管穿孔的关键。对于食管异物并发食管穿孔及颈部脓肿患者行薄层CT扫描具有极高的诊断及鉴别诊断价值。颈部脓肿一经确诊,应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。     

Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography

OBJECTIVE: To determine the effectiveness of using intravenous antibiotics alone to treat clinically stable children with clearly defined deep neck abscesses diagnosed by contrast-enhanced computed tomography (CT). DESIGN: Retrospective chart and CT scan review. SETTING: Tertiary care children's hospital. PATIENTS: The study comprised clinically stable pediatric patients who presented with signs and symptoms of a deep neck infection and who had CT scans demonstrating an abscess in the parapharyngeal space, retropharyngeal space, or both that included (1) a well-formed ring enhancement around a nonenhancing density consistent with fluid and (2) a size greater than 1 cm in every dimension. MAIN OUTCOME MEASURES: Clinical resolution of the signs and symptoms of the deep neck abscess after treatment with intravenous antibiotics. RESULTS: Over a 22-month period (May 1999 to March 2001), 11 children ranging in age from 4 months to 16(1/2) years who had contrast-enhanced CT evidence of deep neck abscess and no clinical evidence of severe symptoms or significant airway compromise were initially treated with intravenous antibiotics. Ten (91%) of the 11 children responded to intravenous antibiotic therapy as their only treatment. All 10 responders began to improve clinically by 48 hours. The symptoms resolved in 5 children by treatment day 3. Five to 8 days of treatment were required to completely resolve the symptoms in the other 5 patients. The 1 child who did not respond to intravenous antibiotic therapy underwent surgical drainage of her deep neck abscess within 12 hours of admission, with purulence discovered at the time of surgery. CONCLUSION: In a select number of clinically stable children, deep neck abscesses diagnosed on contrast-enhanced CT scans using strict radiographic criteria can be effectively treated with intravenous antibiotics alone.     

颈深部感染并发纵隔脓肿1例

颈深部感染合并纵隔脓肿是一种发展迅速的致死性疾病,死亡率高达40％～50％n[1]。我科成功救治1例颈深部感染合并纵隔脓肿患者,现报告如下。     

颈深部多间隙脓肿23例临床分析

目的 总结分析颈深部多间隙脓肿的临床特点和治疗方法,为临床诊疗提供参考.方法 回顾性分析重庆市涪陵中心医院2015年1月～2019年3月收治的23例颈深部多间隙脓肿患者的临床资料.总结其临床特征、实验室检查、影像学特点及微生物学检查结果.分析归纳病因,总结诊疗经过并追踪预后.结果 23例病例中感染来源于牙源性10例,扁...     

Clinical features of 5 patients with descending necrotizing mediastinitis originating from deep neck infection

Descending necrotizing mediastinitis originating from deep neck infection is one of the most serious diseases in the head and neck region. Delayed diagnosis leads to death. We examined 5 cases of descending necrotizing mediastinitis, successfully treated with antibiotics and surgical drainage. Abscess was found in the lower part of the anterior mediastinum in 3 cases and the posterior mediastinum in 2 cases. We first conducted transcervical mediastinal drainage for 3 cases, however, thoracotomy was eventually required in all cases. For cases of abscess in the lower part of the anterior mediastinum, early and aggressive surgical drainage in collaboration with thoracic surgeons is very important and can improve survival.     

Parapharyngeal abscess: comprehensive management protocol

Parapharyngeal infections are rare, but they cause serious morbidity and mortality. Therefore, until now, the recommended treatment of parapharyngeal abscess has been early open surgical drainage. The purpose of this study is to review the clinical course and outcome of treatment in parapharyngeal abscess according to method of treatment. A prospective study was designed for parapharyngeal abscess in patients admitted for deep neck infection. During an 8-year period, from June 1994 to January 2003, 34 patients were enrolled. All had contrast-enhanced computed tomography (CT) imaging and confirmation of an abscess in the parapharyngeal space. All patients were treated with intravenous antibiotics. We treated 19 cases (conservative group) with antibiotics only or needle aspiration and 15 (surgical group) with intraoral or external drainage. The mean duration of hospitalization was 8.2 days in the conservative group and 11.6 days in the surgical group. There was no complication except mediastinitis in 1 case of the conservative group. Because of severe dyspnea, 5 patients required tracheotomy. Neck CT scan is a useful diagnostic tool to detect and establish the treatment plan of parapharyngeal abscess. Parapharyngeal abscess may, in some cases, respond to antibiotics, become localized to the parapharyngeal space and be treated conservatively with no need for early open surgical drainage.     

艾滋病患者伴发耳鼻咽喉疾病死亡4例报告

目的提高对艾滋病患者因耳鼻咽喉疾病导致死亡的认识。方法对4例艾滋病(AIDS)典型死亡病例进行回顾性分析。结果4例病例中,1例因免疫功能降低,扁桃体感染致口腔、咽腔、喉腔及颈部大面积脓肿形成致呼吸道堵塞死亡;1例因血小板计数降低,疑血功能障碍,出凝血时间延长,致持续流鼻血死亡;1例因化脓性中耳炎、乳突感染合并颅内并发症死亡;1例出现咽、喉、气管及支气管黏膜高度水肿致呼吸道堵塞,窒息死亡。结论艾滋病患者可因耳鼻咽喉疾病造成死亡,早期认识及诊断有利于治疗及预防。     

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。