成人咽旁(咽后)间隙脓肿临床危险因素分析

洪艺云; 林功标; 林昶; 叶胜难

doi:10.13201/j.issn.1001-1781.2018.17.004

成人咽旁(咽后)间隙脓肿临床危险因素分析

- 1. 福建医科大学附属宁德市医院耳鼻咽喉科宁德市耳鼻咽喉科研究所(福建宁德, 352100);
- 2. 福建医科大学附属第一医院耳鼻咽喉科

详细信息

通讯作者: 叶胜难,E-mail:1025900431@qq.com

中图分类号: R766.9

收稿日期: 2018-06-15

Adult parapharyngeal and retropharyngeal abscesses: clinical features and their implications for treatment strategy

- 1. Department of Otorhinolaryngology Head and Neck Surgery, Ningde Municipal Hospital affiliated of Fujian Medical University, Ningde Institute of Otolaryngology, Ningde, 352100, China;
- 2. Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Fujian Medical University

More Information

Corresponding author: YE Shengnan, E-mail: 1025900431@qq.com

Received Date: 15 June 2018

摘要

摘要: 目的：探讨影响成人咽旁（咽后）间隙脓肿手术与否的临床危险因素。方法：回顾性分析2006-01-2017-12期间97例成人咽旁和（或）咽后间隙脓肿患者的资料，采用多因素Logistic分析筛选危险因素。结果：共97例患者，立即手术组34例，延时手术组32例，药物治疗组31例，手术率为68%；单独药物治疗成功率为32%。所有患者均经手术切开引流配合足量有效抗生素或单独药物治疗治愈。脓肿直径>2.37cm既是增加手术治疗风险的危险因素，也是增加药物治疗失败风险的危险因素（P<0.001，P=0.002）。平均住院日手术组为17.26 d，单独药物治疗组为10.26 d，手术组住院日长于药物治疗组（P<0.001）。糖尿病组与非糖尿病组手术率差异无统计学意义（χ²=0.523，P>0.05）。糖尿病与多间隙脓肿之间无相关性（r=-0.032，P=0.760）。结论：手术切开引流配合足量有效抗生素是成人咽旁（咽后）间隙脓肿的主要治疗方法，但不是所有患者均需手术治疗，脓肿直径是影响手术与否的危险因素。对于脓肿较大者应积极术前准备，尽早手术介入；而对于脓肿较小者，往往单独药物治疗就可以治愈，应避免手术切开引流，以减少手术并发症并缩短住院日。
- 咽旁脓肿 /
- 咽后脓肿 /
- 危险因素 /
- Logistic分析
Abstract: Objective: To identify the clinical risk factors related to the increased likelihood of surgical drainage and medical therapy failure in parapharyngeal and retropharyngeal abscess. Method: The charts of 93 consecutive patients from January 2006 to April 2017 with parapharyngeal and retropharyngeal abscess were reviewed retrospectively. Logistic regression analysis was used to study the clinical risk factors. Result: A total of 97 adult patients, there were 34 cases in the immediate surgical drainage group and 32 cases in the delayed surgical drainage group and 31 cases treated with medical therapy alone. The rate of operation therapy was 68%, and the success rate of the medical therapy alone was 32%. All patients had successful resolution of their abscesses by medical therapy and(or) surgical drainage. The average length of stay(17.26 d) in the surgical drainage group was longer than the medical therapy group(10.26 d), and the difference was statistically significant(P<0.001). The maximum dimension of abscess>2.37 cm is not only the risk factor of increasing likelihood of surgical drainage, but also that of medical therapy failure(P<0.001, P=0.002). The factors affecting the hospitalization day were whether or not the operation was performed. There was no significant difference in operative rate between diabetic group and non-diabetic group(χ²=0.523, P>0.05). There were no correlation between diabetes mellitus and the multiple space abscesses(r=-0.032, P=0.760). Conclusion: Although a majority of adult parapharyngeal and retropharyngeal abscesses were treated with surgical drainage and sufficient effective intravenous antibiotics, but not all patients need surgical treatment. The diameter of the abscess is a risk factor affecting the operation or not. For those with larger abscesses, the preoperative preparation should be actively prepared and the operation should be intervened as early as possible; for those with smaller abscess, the treatment can be cured alone, and the surgical incision and drainage should be avoided in order to reduce the complications and shorten the hospital days.
- parapharyngeal abscess /
- retropharyngeal abscess /
- risk factors /
- Logistic analysis

HTML全文

参考文献(13)

[1]	PAOLO B R CARLO M, FEDERICA Z, et al.Conservative management of deep neck abscesses in adults:The importance of CECT findings[J].Otolaryngol Head Neck Surg, 2006, 135:894-899.
[2]	LAWRENCE R, BATEMAN N.Controversies in the management of deep neck space infection in children:an evidence-based review[J].Clin Otolaryngol, 2017, 42:156-163.
[3]	CORDESMEYER R, KAUFFMANN P, MARKUS T, et al.Bacterial and histopathological findings in deep head and neck infections:a retrospective analysis[J]Pathol Oral Radiol, 2017, 20:S2212-2213.
[4]	WOODS C R, CASH E D, SMITH A M, et al.Retropharyngeal and parapharyngeal abscesses among children and adolescents in the United States:epidemiology and management trends, 2003-2012[J].J Pediatric Infect Dis Soc, 2016, 5:259-268.
[5]	CHENG J, ELDEN L.Children with deep space neck infections:our experience with 178children[J].Otolaryngol Head Neck Surg, 2013, 148:1037-1042.
[6]	KOSKO J, CASEY J.Retropharyngeal and parapharyngeal abscesses:factors in medical management failure[J].Ear Nose Throat J, 2017, 96:12-15.
[7]	ADIL E, TARSHISH Y, ROBERSON D, et al.The public health impact of pediatric deep neck space infections[J].Otolaryngol Head Neck Surg, 2015, 153:1036-1041.
[8]	DEU-MARTÍN M, SAEZ-BARBA M, LÓPEZ SAN Z, et al.Mortality risk factors in descending necrotizing mediastinitis[J].Arch Bronconeumol, 2010, 46:182-187.
[9]	DABIRMOGHADDAM P, MOHSENI A, NAVVABI Z, et al.Is ultrasonography-guided drainage a safe and effective alternative to incision and drainage fordeep neck space abscesses[J]?J Laryngol Otol, 2017, 131:259-263.
[10]	BIRON V L, KURIEN G, DZIEGIELEWSKI P, et al.Surgical vs ultrasound-guided drainage of deep neck space abscesses:a randomized controlled trial:surgical vs ultrasound drainage[J].Otolaryngol Head Neck Surg, 2013, 42:18-20.
[11]	OBREGÓN-GUERRERO G, MARTÍNEZ-ORDAZ J L, MORENO-AGUILERA E, et al.Deep neck abscess.Factors related to reoperation and mortality[J].Cir Cir, 2013, 81:299-306.
[12]	HOFFMANN C, PIERROT S, CONTENCIN P, et al.Retropharyngeal infections in children:treatment strategies and outcomes[J].Int J Pediatr Otorhinolaryngol, 2011, 75:1099-1103.
[13]	BOLTON M, WANG W, HAHN A, et al.Predictors for successful treatment of pediatric deep neck infections using antimicrobials alone[J].Pediatr Infect Dis J, 2013, 32:1034-1036.