Descending necrotizing mediastinitis: a clinical analysis based on 10 years of published data in China
10.12016/j.issn.2096-1456.2024.02.006
- Author:
LI Chenxi
1
,
2
;
ZHAO Ranran
3
;
SUN Qingchao
4
;
GONG Zhongcheng
5
;
LIU Hui
6
,
7
,
8
;
ZHANG Weina
9
,
10
;
DING Mingchao
11
,
12
,
13
,
14
Author Information
1. 1.Oncological Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Xinjiang Medical University, School / Hospital of Stomatology Xinjiang Medical University 2.Stomatological Research Institute of Xinjiang Uygur Autonomous Region 3.School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology &
2. Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration
3. Oncological Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Xinjiang Medical University, School / Hospital of Stomatology Xinjiang Medical University
4. Department of Thoracic Surgery, the First Affiliated Hospital of Xinjiang Medical University
5. 1Oncological Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Xinjiang Medical University, School / Hospital of Stomatology Xinjiang Medical University. 2Stomatological Research Institute of Xinjiang Uygur Autonomous Region.
6. Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital &
7. School of Stomatology &
8. Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University
9. Ear, Nose &
10. Throat Department, the First Affiliated Hospital of Xinjiang Medical University
11. Department of Oral and Maxillofacial Traumatology &
12. Orthognathic Surgery, the Third Affiliated Hospital of Air Force Medical University &
13. State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases &
14. Shaanxi Clinical Research Center for Oral Diseases
- Publication Type:Journal Article
- Keywords:
odontogenic infection / glandular infection / oral and maxillofacial multispace infection / cervical necrotizing fasciitis / descending necrotizing mediastinitis / retrospective analysis / evidence-based medicine
- From:
Journal of Prevention and Treatment for Stomatological Diseases
2024;32(2):123-130
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical characteristics, diagnosis, treatment, and prognosis of descending necrotizing mediastinitis (DNM) to provide a reference for the early diagnosis and timely treatment of DNM.
Methods:Data on DNM in China was electronically retrieved from the core databases and comprehensively reviewed from June 2012 to June 2023. The infection, pathogenic microorganisms, main symptoms, comorbidities and treatment methods of DNM were analyzed.
Results:The data of a total of 781 DNM patients, with an average age of (52.97 ± 5.64) years, were retrieved, including 554 males and 227 females. Odontogenic source, tonsillitis, pharyngeal abscess, sialoadenitis, upper respiratory tract infection, foreign body injury, or iatrogenic traumatic procedures are common causes. Among these, odontogenic infection is the most common source. Streptococcus sp. (n = 217) and Staphylococcus sp. (n = 82) were most isolated, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa (equally n = 59). A total of 69.4% (542/781) of DNM patients recruited in this study were discovered to have various comorbidities, and more than one-third of these patients (n = 185) had diabetes. Of the broad antibiotics, carbapenem was most frequently used as treatment, and vancomycin was the most frequently coadministered. The mediastinal drainage approach varies widely, and the optimal regimen is still unknown. Seventy-two patients were treated with video-assisted thoracoscopic/mediastinoscopic surgical drainage, 22 patients were treated with percutaneous catheter drainage, 30 underwent the transcervical approach, and 40 underwent thoracotomy. A total of 617 patients who were selected underwent the appropriate combined operation for surgical drainage according to the specific location of the infected focus. The overall mortality rate of all 781 DNM patients included was 11.2%.
Conclusion:The most effective diagnosis and treatment of DNM is a high degree of clinical vigilance followed by prompt and adequate drainage with intensive care, including hemodynamic monitoring, nutritional support, computer tomographic scanning repeated as necessary, and combined use of systemic antibiotics.
- Full text:下行性坏死性纵隔炎 一项基于我国近10年已发表数据的临床分析.pdf
