【摘要】：目的:探討食管后間隙膿腫的臨床表現(xiàn)及治療方法。方法:對27例食管后間隙膿腫患者的臨床資料進(jìn)行回顧分析。21例(77.78%)繼發(fā)于急性食管入口處異物損傷,2例(7.41%)繼發(fā)于陳舊性食管后間隙異物感染,3例(11.11%)繼發(fā)于咽后膿腫,1例(3.70%)原因不明。全部患者行斷層影像學(xué)檢查確診。其中6例患者進(jìn)行保守治療(保守組),6例患者行咽內(nèi)切開排膿術(shù)(咽內(nèi)組),15例患者經(jīng)頸外切口行切開排膿閉式負(fù)壓引流術(shù)(頸外組)。結(jié)果:保守組6例均治愈,平均住院時(shí)間15.6d;咽內(nèi)組有5例治愈,其中2例出現(xiàn)吸入性肺炎并發(fā)感染性休克;余1例并發(fā)縱隔膿腫及肺膿腫感染性休克死亡,本組患者平均住院時(shí)間18.8d;頸外組患者全部治愈,無并發(fā)癥,平均住院時(shí)間9.5d。結(jié)論:食管上段異物損傷及食管后間隙異物殘留是食管后間隙膿腫的主要誘因。斷層影像學(xué)檢查能充分顯示食管后間隙膿腫與其他頸深部間隙,對診斷及治療有重要價(jià)值。經(jīng)頸外切口行切開排膿閉式負(fù)壓引流術(shù)是有效治療方法;經(jīng)咽內(nèi)切口排膿效果差,易導(dǎo)致誤吸誘發(fā)吸入性肺炎,不提倡做首選治療方法;保守治療對于一些無呼吸困難的無基礎(chǔ)病患者也是一種選擇,但需重視對嚴(yán)重并發(fā)癥的早期認(rèn)識及處理。
[Abstract]:Objective: to investigate the clinical manifestation and treatment of posterior esophageal space abscess. Methods: the clinical data of 27 patients with abscess of the posterior space of esophagus were retrospectively analyzed. 21 cases (77.78%) were secondary to foreign body injury at the entrance of acute esophagus, 2 cases (7.41%) were secondary to infection of foreign body in the old posterior space of esophagus, and 21 cases (77.78%) were secondary to foreign body injury at the entrance of esophagus. 3 cases (11.11%) were secondary to retropharyngeal abscess, 1 case (3.70%) had unknown cause. All patients were diagnosed by tomographic examination. Among them, 6 patients underwent conservative treatment (conservative group), 6 patients underwent endopharyngeal incision and purulent operation (endopharyngeal group), and 15 patients underwent incision and purulent negative pressure drainage via external cervical incision (extracervical group). Results: all 6 cases were cured in conservative group, the average hospitalization time was 15.6 days, in the endopharyngeal group, 5 cases were cured, among them 2 cases had inhaled pneumonia complicated with septic shock. The remaining 1 case died of septic shock with mediastinal abscess and lung abscess, the average hospitalization time was 18.8 days in this group, and all the patients in the extra cervical group were cured without complications, and the average hospitalization time was 9.5 d. Conclusion: the injury of upper esophageal foreign body and the residual foreign body in the posterior esophageal space are the main inducement of posterior esophageal space abscess. Computed tomography can fully display the abscess of the posterior esophageal space and other deep cervical spaces, which is of great value in the diagnosis and treatment. Incision and purulent negative pressure drainage via external cervical incision is an effective treatment method, and aspiration-induced aspiration pneumonia is not recommended as the first choice of treatment because of the poor effect of aspiration-induced aspiration through the endopharyngeal incision and the negative pressure drainage through the external cervical incision, and the negative pressure drainage through external cervical incision is an effective treatment. Conservative treatment is also a choice for some patients without dyspnea, but it is necessary to pay attention to the early recognition and management of severe complications.
【作者單位】： 高州市人民醫(yī)院耳鼻咽喉科;
【分類號】：R768.32

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本文編號：2458116