异物所致颈部脓肿

发布时间：2018-12-12 20:44

【摘要】：目的:探讨异物所致颈部脓肿的临床特点、诊断以及治疗方式,加深对异物所致颈部脓肿的认识,以提高对该病的诊断及治疗水平,改善预后。方法:回顾性分析我科2012年-2015年所收治的3例异物所致颈部脓肿患者的临床资料,并复习中英文类似报道病例资料46例,共49例。分析指标包括病史、影像学的选择,治疗方式及手术方式的选择、并发症等。结果:49例患者异物史1天~半年不等;影像学检查选择CT 41例,X线5例,超声2例。采用手术引流脓肿48例(98%),其中选择颈侧切开者31例;术中发现并取出异物46例(93.9%);保守治疗仅1例(2%);仅3例(6.1%)行了气管切开;共17例(34.7%)有并发症出现,包括8例呼吸骤停,其中7例因麻醉插管中脓肿破裂脓液溢出所致,均为婴幼儿,1例因脓肿巨大压迫气道所致,3例脓毒性休克,3例纵隔脓肿,2例声带麻痹,颈动脉破裂1例,所有报道病例均治愈出院。结论:异物所致颈部脓肿病情危重,较普通颈部脓肿并发症多。结合病史及影像学检查,及早诊断发现并取出异物,尽早颈部脓肿引流是治疗关键。
[Abstract]:Objective: to explore the clinical features, diagnosis and treatment of cervical abscess caused by foreign body, and to improve the diagnosis and treatment of the disease. Methods: the clinical data of 3 cases of cervical abscess caused by foreign bodies in our department from 2012 to 2015 were analyzed retrospectively, and 46 cases (49 cases) of similar cases in Chinese and English were reviewed. Analysis included history, choice of imaging, choice of treatment and operation, complications, etc. Results: the history of foreign body in 49 patients ranged from 1 day to 6 months. CT was performed in 41 cases, X-ray in 5 cases and ultrasound in 2 cases. Surgical drainage and abscess were performed in 48 cases (98%), among which 31 cases were selected for lateral cervical incision, 46 cases (93.9%) were found and removed during operation, only 1 case (2%) was treated conservatively, only 3 cases (6.1%) underwent tracheotomy. A total of 17 cases (34.7%) had complications, including 8 cases of respiratory arrest, of which 7 cases were caused by abscess rupture and pus overflow during anesthesia intubation, all of them were infants, 1 case was caused by abscess and huge compression of airway, 3 cases were septic shock. There were 3 cases of mediastinal abscess, 2 cases of vocal cord paralysis and 1 case of carotid artery rupture. All the reported cases were cured and discharged. Conclusion: cervical abscess caused by foreign body is more serious than common cervical abscess. Combined with history and imaging examination, early diagnosis and removal of foreign bodies and early drainage of cervical abscess are the key to treatment.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R653

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