急性纵隔炎的治疗方法

目的　探讨不同方法对 3 8例各种原因引起的急性纵隔炎的治疗。方法　不同原因引起的急性纵隔炎的纵隔胸膜均予切开 ,纵隔广泛清创充分引流 ;前纵隔炎症行对流冲洗 ,对有心包积液者凡开胸探查均予以开窗引流。结果　 3 8例患者中死亡 13例 ,死亡率 3 4.2 % ,余 2 5例痊愈出院。结论　食管破裂、颈胸部枪弹伤、外伤及食管异物镜检损伤者均导致上后纵隔炎症 ,全身症状重 ,不易控制 ,死亡率高 ;正中开胸手术后均导致前纵隔炎症 ,症状一般较轻。上后纵隔炎症一旦确诊应积极行纵隔广泛清创 ,凡是水肿的纵隔胸膜均应切开 ,充分引流 ,防止感染在纵隔内广泛扩散 ,达到控制感染的目的。该方法明显优于单纯胸腔闭式引流。前纵隔炎症行对流冲洗优于单纯引流。早期诊断、充分引流是治疗该病的主要手段。

Acute Mediastinitis: Approach of Therapeutic Method

Objective To evaluate different therapeutic methods in 38 cases with acute mediastinitis induced by various causes. Methods Immediate mediastinal pleura incision, extensive mediastinum debridement and thorough mediastinum drainage were done in these patients. In inflammation of anterior mediastinum, counter current irrigation method was used. For patients with mediastirnitis associated with pericardial effusion, thoracotomy and pericardial window drainage were taken. Results Of the 38 patients, 13 died(34.2%), the remaining 25 patients were cured. Conclusions Esophageal rupture, cervical and thoracic bullet wound and trauma and esophageal injury caused by esophagoscopy for foreign body extraction, all of these lead to superior-posterior mediastinitis accompanied with severe systemic manifestations and can't be easily controlled, and the mortality is high. Sternotomy open chest operations always lead to anterior mediastinitis, in which symptoms are often slight. Once, superior-posterior mediastinitis is diagnosed, immediate, vigorous and extensive debridement of the mediastinum should be done. In order to prevent and control extensive spread of infection in the mediastinum, all the edematous mediastinal pleura should be incised and drained thoroughly. This method is eminently superior to the simple one, close thoracic drainage irrigation is superior to the simple drainage. Early diagnosis and enough drainage are the chief means to treat mediastinitis.