【作者】 张广鑫；

【导师】 张兴义；

【作者基本信息】 吉林大学 ， 临床医学， 2012， 硕士

【摘要】 目的：纵隔脓肿临床发病率低，但病情危重、进展快，临床上主要以外科手术治疗为主，本文主要探讨开胸手术治疗纵隔脓肿的有效性。方法：对2006年6月~2012年1月吉林大学第二临床医学院胸外科收治的9例纵隔脓肿的临床资料进行分析，其中男性6例，女性3例，年龄为35~61岁，平均年龄48岁；其中7例为口腔源性及颈部感染，2例为食管异物致食管穿孔感染；临床表现均伴有发热，其中1例伴全身脓毒血症；影像学上均于CT上发现纵隔内局限性阴影伴纵隔增宽。经诊断明确，积极行开胸手术，充分引流，术后给予抗生素经验用药抗感染，再根据细菌培养结果调整用药，营养支持（6例口腔源性及颈部感染患者术后第1天开始恢复肠内营养，1例脓毒血症患者及2例食管异物穿孔患者术后先给予胃肠减压及肠外营养，待胃肠道功能恢复后给予肠外营养），及呼吸循环对症治疗。结果：经积极外科手术治疗后临床治愈出院8例，住院时间16~26天，平均住院日21天。家属放弃治疗1例，术后生命体征平稳，因经济原因未愈出院，在当地医院继续治疗，一个月后复诊，恢复良好。结论：经积极的开胸手术治疗纵隔脓肿是安全可行的，术中充分打开脓肿分隔，多放置多侧孔引流管，术后给予有效的抗生素抗感染，充分的营养支持，通过外科手段系统治疗纵隔脓肿，可以有效的延缓病情进展，纠正病理改变，降低病死率。更多还原

【Abstract】 Objective:Though the occurrence at a low level,the mediastinal abscess is in a seriously bad condition and progress very fast.The treatments give priority to surgery in clinical conditions.Here we mainly discuss the validity of open thoracotomy on mediastinal abscess.Methods:By analysing the clinical materials collected from the nine patients of mediastinal abscess which the Thoracic Surgical Department in No.2Hospital of Jin Lin University has received since June2006to January2012, there were six male patients and three female patients,the age vary from35to61,the average age goes to48;seven of them were due to the infection from odontogenic and neck, while the other two were due to the infection of perforation caused by foreign body;They all got a fever,and one of them had pyemia;they were all local shadows in mediastinum on CT with a wider mediastinum.They were all operated open thoracotomies actively once they were diagnosed accurately,with incision and drainage possibly.The therapies after the operation involved anti-infection with experienced antibiotics,which were adjusted to the outcome of bacterial culture,nutritional supports(six of them which were due to the infection from odontogenic and neck received parenteral alimentation as soon as possible,while the one with pyemia and the other two which were due to the infection of perforation caused by foreign body received gastrointestinal decompression and enteral nutrition,which were shifted to parenteral alimentation as soon as their gastrointestinal function recovered),and symptomatic treatment on respiratory and circulatory system.Results:There were eight cases who were cured by active operations, the length of being in hospital was during16~26day. There was one case whose family gave up the post-op treatment, and whose vital signs were stable, the patient was discharged from hospital uncured, for the poor economic condition, he continued his post-op treatment back to the local and come back to our hospital for a check in one month’s time, recovering his health well.Conclusion:The proactive open thoracotomy for mediastinal abscess is safe and feasible.We can open abscess septum throughly, lay the drainage tube with multi-side possibly,give the anti-infection effectively and ample nutritional supports after the operation.It is the systemic therapies effectively that can we retard the progress of disease development, correct the pathology, and reduce the mortality.更多还原