DESCENDENDING NECROTIZING MEDIASTINITIS SINGLE CENTER EXPERIENCE
Autori:
Ivan Kovačić, Marijan Kovačić
Sažetak
Descendentni nekrotični medijastinitis rijetka je, ali za život opasna upala, koja nastaje kao komplikacija dubokih upala vrata. Mortalitet bolesnika i dalje je visok (do 40%), bez obzira na upotrebu raznovrsnih antimikrobnih lijekova i kirurških intervencija. U ovom radu opisujemo 7 bolesnika s descendentnim nekrotičnim medijastinitisom, liječenih u našoj bolnici tijekom posljednjih 12 god. Kod 5 bolesnika primarno mjesto upale bile su tonzile i ždrijelo, a u ostala 2 bolesnika odontogena upala donjih molara. Većina bolesnika pripadala je rizičnim skupinama (dijabetes, alkoholizam), prosječne životne dobi od 60,4 god. Nakon dijagnoze postavljene kompjutoriziranom tomografijom (CT) kirurški smo intervenirali kod svih bolesnika. Duboke upale vrata tretirane su kirurški agresivnom cervikotomijom, a kvalitetna medijastinalna drenaža napravljena je kod svih bolesnika transcervikalnim putem. Perioperativna traheotomija (n = 3) izvršena je zbog otoka gornjega dišnog puta, a postoperativna zbog produžene intubacije (n = 1). Samo kod jednog bolesnika naknadno smo izvršili sekundarni kirurški zahvat, odnosno lateralnu torakotomiju radi dekortikacije pleure. Svi su bolesnici uspješno izliječeni, s prosječnom dužinom bolničkog liječenja od 24,6 dana. Za uspješno liječenje descendentnoga nekrotičnog medijastinitisa što prije se mora postaviti dijagnoza, i to uz primjenu kompjutorizirane tomografije. Liječenje zahtijeva istodobnu primjenu snažnih antimikrobnih lijekova, agresivni kirurški debridman vrata i kvalitetnu drenažu medijastinuma, koja se može ostvariti, osim standardnim torakalnim pristupima, i transcervikalnim putem.
Summary
The descending necrotizing mediastinitis is a rare but life-threatening inflammation, and occurs as a complication of deep inflammation of the neck. The mortality rate is still high by 40% despite the use of a variety of potent antimicrobial drugs. We describe 7 patients with the descending necrotizing mediastinitis treated in our hospital during the last 12 years. The primary site of infection in 5 patients were tonsils and pharynx, and in the other two patients odontogenic inflammation of the lower molars. Most of the patients belonged to the risk groups (diabetes mellitus, alcoholism), the average age of 60.4 years. After the diagnosis with computed tomography (CT), we surgically intervened in all patients. Deep neck infections are treated with aggressive surgical cervicotomy and high quality mediastinal drainage was performed with transcervical approach in all patients. Perioperative tracheotomy (n=3) was performed for the upper airway edema and postoperative tracheostomy for extended intubation (n=1).Only in one case, we subsequently conducted a secondary surgical procedure, lateral thoracotomy because of pleural decortication. All patients were successfully cured with an average length of hospitalization was 24.6 days. For successful treatment of the descending necrotizing mediastinitis diagnosis must be set as early as possible and with the use of computed tomography scanning. Treatment requires the simultaneous application of potent antimicrobial drugs, aggressive surgical debridement of the neck and high-quality drainage of the mediastinum, which can be achieved through the transcervical approach.
