食管后间隙脓肿的临床诊治分析

发布时间：2019-04-15 11:44

【摘要】：目的:探讨食管后间隙脓肿的临床表现及治疗方法。方法:对27例食管后间隙脓肿患者的临床资料进行回顾分析。21例(77.78%)继发于急性食管入口处异物损伤,2例(7.41%)继发于陈旧性食管后间隙异物感染,3例(11.11%)继发于咽后脓肿,1例(3.70%)原因不明。全部患者行断层影像学检查确诊。其中6例患者进行保守治疗(保守组),6例患者行咽内切开排脓术(咽内组),15例患者经颈外切口行切开排脓闭式负压引流术(颈外组)。结果:保守组6例均治愈,平均住院时间15.6d;咽内组有5例治愈,其中2例出现吸入性肺炎并发感染性休克;余1例并发纵隔脓肿及肺脓肿感染性休克死亡,本组患者平均住院时间18.8d;颈外组患者全部治愈,无并发症,平均住院时间9.5d。结论:食管上段异物损伤及食管后间隙异物残留是食管后间隙脓肿的主要诱因。断层影像学检查能充分显示食管后间隙脓肿与其他颈深部间隙,对诊断及治疗有重要价值。经颈外切口行切开排脓闭式负压引流术是有效治疗方法;经咽内切口排脓效果差,易导致误吸诱发吸入性肺炎,不提倡做首选治疗方法;保守治疗对于一些无呼吸困难的无基础病患者也是一种选择,但需重视对严重并发症的早期认识及处理。
[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.
【作者单位】：高州市人民医院耳鼻咽喉科;
【分类号】：R768.32

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