颈部坏死性筋膜炎及下行性坏死性纵隔炎伴大出血1例并文献复习

Cervical Necrotizing Fasciitis and Descending Necrotizing Mediastinitis with Massive Hemorrhage: A Case Report and 1 Review of the Literature

摘要: 目的：分析探讨颈部坏死性筋膜炎(CNF)及下行性坏死性纵隔炎(DNM)的急危重病例的早期识别方法、诊治处理策略及介入血管造影栓塞在头颈部感染所致大出血中的应用。方法：回顾性分析1例CNF及DNM伴2次大出血患者的临床成功抢救资料，结合文献总结此类病例的临床表现、影像学检查特点，分析头颈部感染伴出血时止血方法的选取及预后。结果：通过尽早颈深部上纵隔手术探查清创引流联合介入血管造影栓塞止血，以及术后全身管理和积极的静脉抗生素抗感染治疗后，患者最终康复出院，术后3月随访无并发症。结论：CNF及DNM是一种严重的感染性疾病，若不尽快手术干预，死亡率极高。本例报告中，通过头颈外科尽早积极开放手术清创引流换药、介入科及时血管造影明确出血血管并栓塞止血，以及重症监护室对症支持治疗的多学科联合，为CNF及DNM伴大出血病例的诊治提供了一种有效方法和重要参考依据。

Abstract: Objective: To analyze and explore the early identification methods, diagnosis and treatment strate-gies, and the application of interventional angiographic embolization in the treatment of acute crit-ical cases of neck necrotizing fasciitis (CNF) accompanied by descending necrotizing mediastinal in-flammation (DNM) infection that endangers blood vessels. Method: A retrospective analysis was conducted on the clinical data of a patient with CNF accompanied by DNM accompanied by massive bleeding. Combined with relevant literature, the clinical manifestations and imaging features of the disease were summarized, and the selection of hemostatic methods and prognosis for head and neck infections accompanied by bleeding were analyzed. Results: Through surgical exploration, debridement, drainage, interventional angiography and embolization, as well as postoperative electrolyte management and active intravenous antibiotic anti infection treatment, the patient fi-nally recovered and was discharged. There were no complications during the 3-month follow-up af-ter the surgery. Conclusion: CNF and DNM are serious infectious diseases, and the mortality rate will be extremely high if there is no surgical intervention as soon as possible. In this case report, an ef-fective method and important reference basis for the diagnosis and treatment of CNF and DNM pa-tients with massive bleeding were provided through the early and active opening of surgical deb-ridement, drainage and dressing changes in head and neck surgery, timely identification of bleed-ing vessels and embolization for hemostasis in interventional departments, and the multidiscipli-nary combination of symptomatic support and treatment in the intensive care unit.