Deep neck infections in children: A new approach to diagnosis and treatment
Deep neck infections in children: A new approach to diagnosis and treatment
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DOI：
10.1097/00005537-199712000-00010
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发表时间：
1997-12-01
期刊：
影响因子：
2.6
通讯作者：
Brodsky, L
中科院分区：
文献类型：
--
作者：
Nagy, M;Pizzuto, M;Brodsky, L
1991年1月至1996年7月，47名儿童被诊断为深颈感染-蜂窝织炎或脓肿。44例（94%）的对比增强计算机断层扫描（CT）成像与此诊断一致。三名没有CT扫描的患者在手术引流时证实了脓肿。47例感染中，24例（51%）单独使用肠外抗生素治疗有效：7例咽旁感染，1例咽后感染，16例合并感染。通过CT扫描，这些感染表现为24例中的17例（71%）蜂窝织炎，24例中的3例（13%）脓肿，24例中的4例（17%）不完全脓肿。该组的平均住院时间为4.8天，症状通常在24小时内改善。47例感染中有23例（49%）进行了手术引流：3例咽旁感染，17例合并感染，3例具体部位不明。在这23名儿童中的22名（96%）中，经口脓肿引流被用作主要手术方法。在这22例患者中，21例（95%）完全消退，无并发症或复发; 1例脓肿需要后续外部入路。CT增强扫描显示所有深颈感染均位于大血管内侧（通常为前内侧）。估计体积大于2000 mm（3）的脓肿更有可能接受手术，但这些差异无统计学意义。增强CT扫描的使用提供了脓肿大小、位置和大血管相对位置的信息，以确保安全和成功的经口引流。因此，我们建议CT辅助经口引流联合咽后/咽旁脓肿和选择孤立的咽旁脓肿，不响应肠外抗生素。
Forty-seven children presented with the diagnosis of a deep neck infection-either cellulitis or abscess-between January 1991 and July 1996. Forty-four (94%) had contrast-enhanced computed tomography (CT) imaging consistent with this diagnosis. Three patients with no CT scan had comfirmation of an abscess at surgical drainage. Parenteral antibiotics alone were effective in the treatment of 24 of 47 infections (51%): seven parapharyngeal, one retropharyngeal, and 16 combined. By CT scan these infections represented cellulitis in 17 of 24 (71%), an abscess in three of 24 (13%), and incomplete abscess in four of 24 (17%). The average duration of hospitalization for this group was 4.8 days, with symptomatic improvement usually seen within 24 hours. Surgical drainage was performed on 23 of 47 infections (49%): three parapharyngeal, 17 combined, and three of unknown specific location. In 22 of these 23 children (96%), transoral drainage of the abscess was used as the primary surgical approach. In 21 of these 22 (95%) there was complete resolution without complications or recurrence; one abscess required a subsequent external approach. CT scanning with contrast revealed that all deep neck infections were located medial (usually anteromedial) to the great vessels. Abscesses with volumes estimated to be greater than 2000 mm(3) were more likely to undergo surgery, but these differences were not statistically significant. The use of contrast-enhanced CT scanning provides information regarding abscess size, location, and relative position of the great vessels for safe and successful transoral drainage. Thus we recommend CT-assisted transoral drainage for combined retropharyngeal/parapharyngeal abscesses and selected isolated parapharyngeal abscesses that do not respond to parenteral antibiotics.