颈部坏死性筋膜炎外科引流与清创的效果评价

目的: 探讨颈部坏死性筋膜炎的外科引流与清创方法。方法: 收集解放军第252医院2008年1月—2014年4月期间诊断为颈部坏死性筋膜炎的患者共12例,其中男8例,女4例,所有患者急诊在全麻下行颈部感染切开引流。术后采用CT复查,明确疾病控制或进展情况,必要时再次手术切开和清创。分析手术切口的选择及治疗效果。结果: 12例患者中,2例采用改良颈部“T”形切口,其余采用颈部横形切口。1例后纵隔脓肿采用经胸纵隔引流切口。1例并发高位咽后间隙感染,经颈部切开的同时,采用咽后壁切口。9例患者单次切开后病情即趋于稳定、好转,最短5 d,最长8 d出现大量坏死筋膜脱落。另外3例分别接受2次、3次和4次手术。12例患者死亡3例,死亡率为25.0%。结论: 颈部坏死性筋膜炎是一种进展迅速、高致死率的感染性疾病。手术切开引流和清创是控制疾病进展的重要手段。颈部横行切口可以充分暴露各颈部间隙,应根据病情进展,适时再次手术切开和清创。

Surgical drainage and debridement of cervical necrotizing fasciitis

PURPOSE: To investigate the role of surgical drainage and debridement in management of cervical necrotizing fasciitis (CNF). METHODS: We retrospectively reviewed 12 patients (8 males, 4 females) with CNF admitted to the 252nd Hospital of PLA between January 2008 and April 2014. All the patients underwent surgical drainage and debridement. In patients with no clinical improvement, repeated surgical interventions were performed. RESULTS: Surgical drainage and debridement was performed via paralleled transcervical incisions in 10 patients, modified T-shaped incision in 2 patients. In one case with a higher anatomical level in the retropharyngeal space infection, a horizontal incision was made in the posterior pharyngeal wall. One patient with a posterior mediastinal abscess underwent a transthoracic drainage. Of 12 cases, nine had single incision, who demonstrated a stable process and a large number of necrotic fascia tissue fall off from the wound with a shortest time of 5 days and a longest one of 8 days postoperatively. Another 3 patients received 2, 3 and 4 times of surgical intervention respectively because of the worse progress. Three patients died of multiorgans failure with an overall mortality rate of 25.0%. CONCLUSIONS: CNF is an aggressive infection associated with high mortality. Surgical drainage and debridement is an important mean in controlling the progress of the disease. Paralleled transcervical incisions can fully expose the fascial spaces of neck. Repeated surgical intervention is recommended in cases with worse progresses.