纵隔脓肿的诊断与治疗（附8例分析）.pdfVIP

中国临床医学 20()7年 12月 第 14卷 第6期 Clinical Medical Journal of China，2007．Vo1．14，No．6 795 · 论著· 纵隔脓肿的诊断与治疗(附8例分析) 贾卫光 摘要 目的：探讨纵隔脓肿的诊断与治疗。方法：对2001年1月 2006年6月收治的8例纵隔脓肿的临床资料进行分析。其 中男性6例，女性2例，年龄39～75岁；5例为中上纵隔脓肿，3例为下纵隔脓肿；诊断明确后均给予积极的手术引流、抗感染 治疗和营养支持治疗。结果：经过治疗后治愈7例，住院时间1()～61 d，除1例食管癌颈部吻合术后2年吻合口复发癌穿孔的 患者出现食管狭窄外，其余6例均能正常饮食。死亡1例。结论：纵隔脓肿明确诊断后应及早手术，给予有效的抗生素、充分 的引流；足够的营养支持及细致的呼吸道管理。 关键词 纵隔疾病； 引流； 脓肿 中图分类号 R655．5 文献标识码 A Diagnosis and Treatment of Mediastinal Abscess：A 8-cases Report )IA Weiguang Tai Zhou People 8 Hospital()f)iangsu Province Taizhou 225300 Abstract Objective：To summarize the experience of diagnosis and treatment of mediastinaI abscess．Methods：The ClinicaI da ta of 8 patients with mediastinal abscess admitted by TaiZhou People S Hospital from January 2001 to June 20()6 were reviewed retrospectively．Five of the patients were diagnosed as superior mediastinaI abscess and three cases were inferior mediastinaI ab scess．All the patients received active surgical drainage，antibiotics and nutritional support．Results：Of the 8 patients，6 were male and 2 were female，age range from 39 to 75．7 patients were cured．while patient died，the total mortality rate was 1 2．5％．Hospital length of stay ranged from 1 0 tO 62 days．Except for one anastomotic stenosis，the other 6 patients could eat normal diet．Conclusion：Early diagnosis，effective antibiotics，feasible surgical drainage，sufficient nutritional support and care fuI respiratory tract nursing are key tO the t reatment of mediastina】abscess． Key Words MediastinaI disease； Drainage； Abscess 纵隔脓肿是一种发展迅速的致死性疾病，病死 均有发热，6例患者体温多在38．5C以上。5例有 率高达40 ～5O [1一。纵隔中上段脓肿形成主要 胸痛，5例病情严重者伴有感染性休克，2例患者因 是颈部感染下行及中上纵隔感染本身引起，如牙源 为严重的上纵隔感染导致喉头水肿，出现呼吸困难。 性感染、咽旁隙及咽后隙感染下行或是上段食管损 上纵隔感染患者多数(4／5)伴有颈部疼痛及活动障 伤引起纵隔脓肿。下纵隔脓肿形成主要源于下段食