Surgical Treatment for Descending Necrotizing Mediastinitis / 대한흉부외과학회지
The Korean Journal of Thoracic and Cardiovascular Surgery
;
: 82-88, 2008.
Artigo
em Coreano
| WPRIM
| ID: wpr-62287
ABSTRACT
BACKGROUND:
Descending necrotizing mediastinitis (DNM) is a serious disease originating in odontogenic or oropharyngeal infection with high mortality despite adequate antibiotics and aggressive surgery. We analyzed results of treatment for DNM. MATERIAL ANDMETHOD:
We studied 8 cases diagnosed as DNM from 1998 to 2007. All patients received emergent surgical drainage and debridement with broad spectrum antibiotics just after diagnosis. Antibiotics were changed after bacterial susceptibility testing. The surgical approach included 2 cases of cervicotomy, 6 cases of cervicotomy, and a thoracotomy.RESULT:
The interval between symptom onset and hospitalization was 4.6+/-1.8 days (1~9 day). DNM originated in 4 cases of odontogenic infection (50%), 2 cases of oropharyngeal infection (25%), and 2 cases of unknown origin (25%). Causative organisms were found in 6 cases; Streptococcus in 4 cases, Staphylococcus in 1 case, and Klebsiella in 1 case. The Endo DNM classification was type I (2 cases), IIA (3 cases), and IIB (3 cases). The incidence of thoracotomy was 75%. The surgical mortality rate was 25% (2/8). The cause of death was multiple organ failure caused by septic shock. All mortality cases received only cervicotomy and aggravated infections after initial drainage.CONCLUSION:
Early diagnosis, immediate surgical drainage, and adequate antibiotics, including covered anaerobes, are required. Thoracotomy should be performed with cervicotomy even for localized DNM.
Texto completo:
DisponíveL
Índice:
WPRIM (Pacífico Ocidental)
Assunto principal:
Choque Séptico
/
Staphylococcus
/
Streptococcus
/
Toracotomia
/
Drenagem
/
Incidência
/
Causas de Morte
/
Desbridamento
/
Diagnóstico Precoce
/
Hospitalização
Tipo de estudo:
Estudo diagnóstico
/
Estudo de incidência
/
Estudo prognóstico
/
Estudo de rastreamento
Limite:
Humanos
Idioma:
Coreano
Revista:
The Korean Journal of Thoracic and Cardiovascular Surgery
Ano de publicação:
2008
Tipo de documento:
Artigo
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