Kang, Shin-Kwang
(Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine)
,
Lee, Seok-Kee
(Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine)
,
Oh, Hyun-Kong
(Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine)
,
Kang, Min-Woong
(Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine)
,
Na, Myung-Hoon
(Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine)
,
Yu, Jae-Hyeon
(Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine)
,
Koo, Bon-Seok
(Department of Otorhinolaryngology, Chungnam National University Hospital, Chungnam National University School of Medicine)
,
Lim, Seung-Pyung
(Department of Thoracic and Cardiovas)
Background: Deep neck infections (DNI) can originate from infection in the potential spaces and fascial planes of the neck. DNI can be managed without surgery, but there are cases that need surgical treatment, especially in the case of mediastinal involvement. The aim of this study is to identify cl...
Background: Deep neck infections (DNI) can originate from infection in the potential spaces and fascial planes of the neck. DNI can be managed without surgery, but there are cases that need surgical treatment, especially in the case of mediastinal involvement. The aim of this study is to identify clinical features of DNI and analyze the predisposing factors for mediastinal extension. Materials and Methods: We reviewed medical records of 56 patients suffering from DNI who underwent cervical drainage only (CD group) and those who underwent cervical drainage combined with mediastinal drainage for descending necrotizing mediastinitis (MD group) from August 2003 to May 2009 and compared the clinical features of each group and the predisposing factors for mediastinal extension. Results: Forty-four out of the 56 patients underwent cervical drainage only (79%) and 12 patients needed both cervical and mediastinal drainage (21%). There were no differences between the two groups in gender (p=0.28), but the MD group was older than the CD group (CD group, $44.2{\pm}23.2$ years; MD group, $55.6{\pm}12.1$ years; p=0.03). The MD group had a higher rate of co-morbidity than the CD group (p=0.04). The CD group involved more than two spaces in 14 cases (32%) and retropharyngeal involvement in 12 cases (27%). The MD group involved more than two spaces in 11 cases (92%) and retropharyngeal involvement in 12 cases (100%). Organism identification took place in 28 cases (64%) of the CD group and 3 cases of (25%) the MD group (p=0.02). The mean hospital stay of the CD group was $21.5{\pm}15.9$ days and that of the MD group was $41.4{\pm}29.4$ days (p=0.04). Conclusion: The predisposing factors of mediastinal extension in DNI were older age, involvement of two or more spaces, especially including the retropharyngeal space, and more comorbidities. The MD group had a longer hospital stay, higher mortality, and more failure to identify causative organisms of causative organisms than the CD group.
Background: Deep neck infections (DNI) can originate from infection in the potential spaces and fascial planes of the neck. DNI can be managed without surgery, but there are cases that need surgical treatment, especially in the case of mediastinal involvement. The aim of this study is to identify clinical features of DNI and analyze the predisposing factors for mediastinal extension. Materials and Methods: We reviewed medical records of 56 patients suffering from DNI who underwent cervical drainage only (CD group) and those who underwent cervical drainage combined with mediastinal drainage for descending necrotizing mediastinitis (MD group) from August 2003 to May 2009 and compared the clinical features of each group and the predisposing factors for mediastinal extension. Results: Forty-four out of the 56 patients underwent cervical drainage only (79%) and 12 patients needed both cervical and mediastinal drainage (21%). There were no differences between the two groups in gender (p=0.28), but the MD group was older than the CD group (CD group, $44.2{\pm}23.2$ years; MD group, $55.6{\pm}12.1$ years; p=0.03). The MD group had a higher rate of co-morbidity than the CD group (p=0.04). The CD group involved more than two spaces in 14 cases (32%) and retropharyngeal involvement in 12 cases (27%). The MD group involved more than two spaces in 11 cases (92%) and retropharyngeal involvement in 12 cases (100%). Organism identification took place in 28 cases (64%) of the CD group and 3 cases of (25%) the MD group (p=0.02). The mean hospital stay of the CD group was $21.5{\pm}15.9$ days and that of the MD group was $41.4{\pm}29.4$ days (p=0.04). Conclusion: The predisposing factors of mediastinal extension in DNI were older age, involvement of two or more spaces, especially including the retropharyngeal space, and more comorbidities. The MD group had a longer hospital stay, higher mortality, and more failure to identify causative organisms of causative organisms than the CD group.
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제안 방법
However, when the CT scan showed an abscess spreading or localized persistent septic manifestation, repeated mediastinal drainage was performed. The CT scans were performed at the third, seventh, and fourteenth postoperative day routinely, or whenever routine chest X-rays showed abnormal findings (Fig. 1).
We report the surgical results of the cervical drainage group in DNI compared with the group to which mediastinal drainage was added. The clinical features and predisposing factors of DNI progressing to DNM were analyzed.
The medical records of patients who underwent surgical treatment for DNI and DNM from August 2003 to May 2009 were reviewed retrospectively. Their demographics, etiologies associated with systemic diseases (hypertension, diabetes mellitus, liver cirrhosis, and chronic renal failure), preoperative condition (sepsis), disease interval, infectious origin, bacteriology, radiology, duration of hospitalization, and outcomes were reviewed. Sepsis was defined as high fever (＞38.
대상 데이터
The two mortalities in the MD group were male, in septic condition preoperatively, had Type II B disease, and had Streptococcus identified. The patient who was diagnosed with DNM 11 days after initial cervical drainage died from multi-organ failure despite three thoracotomies followed by a median sternotomy. The other patient’s referral to our institution was delayed after the onset of symptoms, and he died from intractable shock.
성능/효과
02). Causative organisms of the CD group infections were 13 cases of Streptococcus (29.5%), 7 of Staphylococcus (15.9%), 5 of Klebsiella (11.5%), and 3 of Pseudomonas (6.8%), while 16 remained unidentified (36.4%) (Tables 1, 2).
The two mortalities in the MD group were male, in septic condition preoperatively, had Type II B disease, and had Streptococcus identified. The patient who was diagnosed with DNM 11 days after initial cervical drainage died from multi-organ failure despite three thoracotomies followed by a median sternotomy.
참고문헌 (16)
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