Descending necrotizing mediastinitis:a clinical analysis based on 10 years of published data in China
10.12016/j.issn.2096-1456.2024.02.006
- VernacularTitle: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
- Author:
Chenxi LI
1
,
2
,
3
;
Ranran ZHAO
;
Qingchao SUN
;
Zhongcheng GONG
;
Hui LIU
;
Weina ZHANG
;
Mingchao DING
Author Information
1. 新疆医科大学第一附属医院(附属口腔医院)口腔颌面肿瘤外科,新疆维吾尔自治区乌鲁木齐(830054)
2. 新疆维吾尔自治区口腔医学研究所,新疆维吾尔自治区乌鲁木齐(830054)
3. 华中科技大学同济医学院附属协和医院口腔医学中心,口腔颌面发育与再生湖北省重点实验室,湖北武汉(430022)
- 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 pa-tients included was 11.2％.Conclusion The most effective diagnosis and treatment of DNM is a high degree of clini-cal vigilance followed by prompt and adequate drainage with intensive care,including hemodynamic monitoring,nutri-tional support,computer tomographic scanning repeated as necessary,and combined use of systemic antibiotics.
