Clinical study of cervical necrotizing fasciitis accompanied with descending necrotizing mediastinitis treated with cervical double parallel incision combined with mediastinoscope or thoracoscope
10.3760/cma.j.issn.1002-0098.2019.05.004
- VernacularTitle: 颈部双平行切口联合纵隔镜或胸腔镜治疗颈部坏死性筋膜炎伴下行性坏死性纵隔炎的临床初探
- Author:
Zhichao ZHU
1
;
Xu YANG
1
;
Feng ZHENG
2
;
Liang ZHENG
3
;
Tianshu XU
1
Author Information
1. Department of Stomatology, The First People′s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou 213000, China
2. Intensive Care Unit, The First People′s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou 213000, China
3. Department of Thoracic Surgery, The First People′s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou 213000, China
- Publication Type:Journal Article
- Keywords:
Fasciitis, necrotizing;
Mediastinitis;
Drainage;
Thoracoscopes;
Mediastinoscopes
- From:
Chinese Journal of Stomatology
2019;54(5):309-314
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the experience of applying cervical double parallel incision combined with mediastinoscope or thoracoscope in the treatment of cervical necrotizing fasciitis (CNF) accompanied with descending necrotizing mediastinitis (DNM), so as to provide a reference for clinical practice.
Methods:The clinical data of six patients with CNF accompanied with DNM who were admitted to the Department of Stomatology and the Department of Otolaryngology Head and Neck Surgery, The First People′s Hospital of Changzhou from September 2014 to September 2018 were retrospectively analyzed. All of the six patients were confirmed by CT of neck and chest, among whom there were two males and four females aged from 48 to 73. Three patients were treated with cervical double parallel incision combined with mediastinoscope to be combined with cervical and thoracic drainage under general anesthesia while the other three with cervical double parallel incision combined with thoracoscope to be combined cervical and thoracic drainage under general anesthesia. The CT of neck and chest as well as infectious indicators including hematology, C-reactive protein (CRP) and procalcitonin (PCT) were reexamined during the postoperative period.
Results:The cervical and thoracic combined drainage was unobstructed in all of the six patients, no secondary surgery was performed, and the infectious indicators gradually decreased. All patients had off-bed activities on the first day after the operation, were all cured and discharged after an average of 21 days (16 to 36 days) in hospital and followed up for an average of 18 months (4 to 30 months) after the operation. None of them experienced infection relapse, and they were all satisfied with the appearance of the cervical incision.
Conclusions:Cervical double parallel incision combined with mediastinoscope or thoracoscope for the treatment of CNF accompanied with DNM has the advantages of complete drainage, small trauma, excellent efficacy and aesthetic operative area, thus being deserved to be clinically popularized.
