摘要
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。
Objective To discuss the etiology, diagnosis and treatment of cervical necrotizing fasciitis(CNF) in order to improve the awareness of surgeons to CNF.Methods Clinical data of 16 patients suffering from CNF treated in our hospital from Jan 2011 to Dec 2017 were analyzed retrospectively. Emergency operation was performed to all patients. Of them, 10 underwent tracheotomy, 10 received surgical debridement for one time and 6 for more than two times respectively.Results All the patients were cured with surgical treatment and medical therapy. 3 patients with concurrent diabetes mellitus developed into descending necrotizing mediastinitis(DNM), and got healed by combination of surgical debridement and thoracoscopic surgery. The decannulation rate was 100% without any complications. The mean hospitalization time was 32 days. After discharge, all patients had been followed up for 3 months, and recurrence occurred in none.Conclusion CNF is a kind of rapidly progressive soft tissue infection with high mortality. Early diagnosis, radical surgical debridement, combined application of sensitive antibiotics and supportive therapy are key determinants for the diagnosis and treatment of this disease.
作者
石嘉俪
王颖
周争
邓星程
刘君
李吉平
SHI Jia-li;WANG Ying;ZHOU Zheng;DENG Xin-cheng;LIU Jun;LI Ji-ping(Department of Otolaryngology,Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University,Shanghai 200127,China)
出处
《中国耳鼻咽喉颅底外科杂志》
CAS
2019年第1期78-83,共6页
Chinese Journal of Otorhinolaryngology-skull Base Surgery
基金
上海市科学技术委员会上海自然基金项目(18ZR1423300)
浦东新区卫计委联合攻关项目(PW2017D-2)
关键词
颈部坏死性筋膜炎
下行坏死性纵隔炎
感染
清创
Cervical necrotizing fasciitis
Descending necrotizing mediastinitis
Infection
Debridement
