• 1. 青島大學醫(yī)學院附屬醫(yī)院 胸外科;;
  • 2. 口腔科,山東青島 266003;

目的 探討下行性壞死性縱隔炎(DNM)的診斷和治療方法?!》椒ā』仡櫺苑治?988年1月至2009年12月青島大學醫(yī)學院附屬醫(yī)院收治11例DNM患者的臨床資料,其中男8例,女3例;年齡25~71 (55±3)歲。早期收治的患者外科治療采用頸部清創(chuàng)、引流,或經(jīng)頸部縱隔引流;后期收治的患者采用頸、胸部同期清創(chuàng)、引流及術(shù)后沖洗?!〗Y(jié)果 行單純頸部清創(chuàng)、引流及經(jīng)頸部縱隔引流的7例患者中死亡4例,均死于嚴重縱隔感染導致多器官功能衰竭,3例生存患者均為感染尚未侵犯下縱隔和胸腔;行頸、胸部清創(chuàng)、引流和沖洗的4例患者全部治愈。隨訪7例,隨訪時間3個月,患者恢復良好?!〗Y(jié)論 DNM病情兇險,一旦發(fā)病迅速進展為膿毒血癥,甚至死亡。重視口咽部和頸部感染患者的胸部癥狀、體征變化,及時行胸部CT檢查是盡早診斷DNM的關(guān)鍵。盡早進行頸、胸部徹底清創(chuàng)、充分引流及有效沖洗是治療DNM成功的關(guān)鍵。

引用本文: 魏煜程,祝凱,王明釗,尚偉,袁榮濤,沈毅. 下行性壞死性縱隔炎的診斷與治療. 中國胸心血管外科臨床雜志, 2012, 19(5): 569-571. doi: 復制

版權(quán)信息: ?四川大學華西醫(yī)院華西期刊社《中國胸心血管外科臨床雜志》版權(quán)所有,未經(jīng)授權(quán)不得轉(zhuǎn)載、改編

1.  Pearse HE. Mediastinitis following cervical suppuration. Ann Surg 1938, 108 (4):588-611.
2.  Brunelli A, Sabbatini A, Catalini G, et al. Descending necrotizing mediastinitis. Surgical drainage and tracheostomy. Arch Otolaryngol Head Neck Surg, 1996, 122 (12):1326-1329.
3.  Estrera AS, Landay MJ, Grisham JM, et al. Descending necrotizing mediastinitis. Surg Gynecol Obstet, 1983, 157 (6):545-552.
4.  Corsten MJ, Shamji FM, Odell PF, et al. Optimal treatment of descending necrotising mediastinitis. Thorax, 1997, 52 (8): 702-708.
5.  Endo S, Murayama F, Hasegawa T, et al. Guideline of surgical management based on diffusion of descending necrotizing mediastinitis. Jpn J Thorac Cardiovasc Surg, 1999, 47 (1):14-19.
6.  Wheatley MJ, Stirling MC, Kirsh MM, et al. Descending necrotizing mediastinitis:transcervical drainage is not enough. Ann Thorac Surg, 1990, 49 (5):780-784.
7.  Freeman RK, Vallières E, Verrier ED, et al. Descending necrotizing mediastinitis:An analysis of the effects of serial surgical debridement on patient mortality. J Thorac Cardiovasc Surg, 2000, 119 (2):260-267.
8.  Casanova J, Bastos P, Barreiros F, et al. Descending necrotising mediastinitis--successful treatment using a radical approach. Eur J Cardiothorac Surg, 1997, 12 (3):494-496.
9.  Roberts JR, Smythe WR, Weber RW, et al. Thoracoscopic management of descending necrotizing mediastinitis. Chest, 1997, 112 (3):850-854.
10.  Min HK, Choi YS, Shim YM, et al. Descending necrotizing mediastinitis:a minimally invasive approach using video-assisted thoracoscopic surgery. Ann Thorac Surg, 2004, 77 (1):306-310.
11.  Chen KC, Chen JS, Kuo SW, et al. Descending necrotizing mediastinitis:a 10-year surgical experience in a single institution. J Thorac Cardiovasc Surg, 2008, 136 (1):191-198.
12.  Son HS, Cho JH, Park SM, et al. Management of descending necrotizing mediastinitis using minimally invasive video-assisted thoracoscopic surgery. Surg Laparosc Endosc Percutan Tech, 2006, 16 (6):379-382.
  1. 1.  Pearse HE. Mediastinitis following cervical suppuration. Ann Surg 1938, 108 (4):588-611.
  2. 2.  Brunelli A, Sabbatini A, Catalini G, et al. Descending necrotizing mediastinitis. Surgical drainage and tracheostomy. Arch Otolaryngol Head Neck Surg, 1996, 122 (12):1326-1329.
  3. 3.  Estrera AS, Landay MJ, Grisham JM, et al. Descending necrotizing mediastinitis. Surg Gynecol Obstet, 1983, 157 (6):545-552.
  4. 4.  Corsten MJ, Shamji FM, Odell PF, et al. Optimal treatment of descending necrotising mediastinitis. Thorax, 1997, 52 (8): 702-708.
  5. 5.  Endo S, Murayama F, Hasegawa T, et al. Guideline of surgical management based on diffusion of descending necrotizing mediastinitis. Jpn J Thorac Cardiovasc Surg, 1999, 47 (1):14-19.
  6. 6.  Wheatley MJ, Stirling MC, Kirsh MM, et al. Descending necrotizing mediastinitis:transcervical drainage is not enough. Ann Thorac Surg, 1990, 49 (5):780-784.
  7. 7.  Freeman RK, Vallières E, Verrier ED, et al. Descending necrotizing mediastinitis:An analysis of the effects of serial surgical debridement on patient mortality. J Thorac Cardiovasc Surg, 2000, 119 (2):260-267.
  8. 8.  Casanova J, Bastos P, Barreiros F, et al. Descending necrotising mediastinitis--successful treatment using a radical approach. Eur J Cardiothorac Surg, 1997, 12 (3):494-496.
  9. 9.  Roberts JR, Smythe WR, Weber RW, et al. Thoracoscopic management of descending necrotizing mediastinitis. Chest, 1997, 112 (3):850-854.
  10. 10.  Min HK, Choi YS, Shim YM, et al. Descending necrotizing mediastinitis:a minimally invasive approach using video-assisted thoracoscopic surgery. Ann Thorac Surg, 2004, 77 (1):306-310.
  11. 11.  Chen KC, Chen JS, Kuo SW, et al. Descending necrotizing mediastinitis:a 10-year surgical experience in a single institution. J Thorac Cardiovasc Surg, 2008, 136 (1):191-198.
  12. 12.  Son HS, Cho JH, Park SM, et al. Management of descending necrotizing mediastinitis using minimally invasive video-assisted thoracoscopic surgery. Surg Laparosc Endosc Percutan Tech, 2006, 16 (6):379-382.