Diagnosis and Therapy of Patients with Descending Necrotizing Mediastinitis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LUO Lifeng , CAO Wanying , CHENG Qingshu

1. Department of Thoracic, Tangdu Hospital, the Fourth Military Medical University, Xi’an 710038, P.R. China;;
2. Tongchuan Mining Administration Hospital, Tongchuan 727000, Shanxi, P.R. China;

Corresponding author：

Keywords：

Descending necrotizing mediastinitis; Computer tomography; Surgical drainage

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Abstract： Objective To explore the diagnosis and treatment of descending necrotizing mediastinitis (DNM). Methods We retrospectively analyzed the records of eight DNM patients treated at Tangdu Hospital between 2006 and 2009 year. There were 7 males and 1 female aged from 21-98 years with a median age of 49.5 years. The diagnostic criteria included clinical manifestations, neck and chest CT scans, and bacteriological culture. Six of the patients had odontogenic infections and six had diabetes. Antibiotic treatment, incision drainage, and other symptomatic treatments were applied. Two patients received cervical incision drainage, five received thoracotomy, and one received video-assisted thoracoscopic surgery (VATS). Results After treatment, six patients recovered and two died of heart failure and neck vessel rupture. According to the bacterial culture, six patients presented mixed infections, and four of these presented mixed aerobic and anaerobic infections. The mean operation time was 75.6 minutes, the average volume of pus removed during the operation was 318.7 ml, and the average inpatient stay was 18 days. At six months follow-up, all six surviving patients showed improvements in quality of life. Conclusion The valid diagnosed criteria of DNM include history, sign, symptom, neck and chest CT scanning, and secretion culture.DNM mortality can be reduced by employing broad spectrum antibiotics early in treatment, individual surgical managements, and effective treatments for complicating illnesses.

Citation： LUO Lifeng,CAO Wanying,CHENG Qingshu,et al .. Diagnosis and Therapy of Patients with Descending Necrotizing Mediastinitis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(1): 43-47. doi: Copy

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2.	Iwata T, Sekine Y, Shibuy K, et al. Early open thoracotomy and mediastinopleural irrigation for severe descending necrotizing mediastinitis. Eur J Cardiothorac Surg, 2005, 28(3)：384-388..
3.	Librizzi D, Mazzola E, Maragliano S, et a1. The descending necrotizing mediastinitis. G Chir, 2008, 29(8-9)：347-350.
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5.	Kaira K, Yasuoka H, Ichikawa T, et al. Descending necrotizing mediastinitis after upper gastrointestinal endoscopy. Endoscopy, 2007, 39( Suppl 1)：e29.
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7.	王建立.牙源性下行性坏死性纵隔炎临床分析.中外医疗，2010,29（21）：94.
8.	Pinto A, Scaglione M , Scuderi MG, et al. Infections of the neck leading to descending necrotizing mediastinitis： Role of multi-detector row computed tomography. Eur J Radiol, 2008, 65(3)：389-394.
9.	史向阳,井松,赵文刚,等.下行性坏死性纵隔炎的诊治及护理.中国实用护理杂志：下旬版，2005，21(6)：38.
10.	Estrera AS, Landay MJ, GrishamJM, et al. Descending necrotizing mediastinitis. Surg Gynecol Obstet, 1983, 157(6)：545-552.
11.	Righini CA, Motto E, Ferretti G, et al. Diffuse cervical cellulites and descending necrotizing mediastinitis. Ann Otolaryngol Chir Cervicofac, 2007, 124(6)：292-300.
12.	Ghimire A, Bhattarai M, Kumar M, et al. Descending necrotizing mediastinitis： a fatal complication of neglected esophageal foreign body. Kathmandu Univ Med J (KUMJ), 2007, 5(1)：98-101.
13.	徐富仁，辛定一. 急性感染性纵隔炎的诊断和治疗(25例报告).中华胸心血管外科杂志,1994, 10(2)：132-133,.
14.	刘晶春，刘钢. 下行性坏死性纵隔炎合并右上肺感染1例分析. 中国误诊学杂志, 2008, 8(12)：3006-3007.
15.	Roccia F, Pecorari GC, Oliaro A, et a1. Ten years of descending necrotizing mediastinitis： management of 23 cases. J Oral Maxillofac Surg, 2007, 65(9)：1716-1724.
16.	Chen KC, Chen JS, Kuo SW, et al. Descending necrotizing mediastinitis：a 10-year surgical experience in a single institution. J Thorac Cardiovasc Surg, 2008, 136(1)：191-198.
17.	上官诚芳，吴继昌，王士礼，等.严重颈深部感染引发下行性坏死纵隔炎1例.临床耳鼻喉头颈外科杂志, 2009, 7(23)：665-666.
18.	Harar RP, Cranston C, Warwick-Brown N. Descending necrotizing mediastinitis： report of a case following steroid neck injection.J Laryngol Otol,2002, 116(10)：862-864.
19.	Nikolaos ND, Apostolakis EE, Marangos MN, et a1. A less invasive management of post-thyroidectomy descending necrotizing mediastinitis is feasible：a case report and literature review. Med Sci Monit, 2007, 13(7)：CS83-87.
20.	Caputo FJ, Magnotti LJ, Hauser CJ, et a1. Descending necrotizing mediastinitis： unique complication of central venous catheterization. Surg Infect(Larchmt), 2007, 8(6)：61l-614.
21.	林崇翔，丁熙，麻益可，等.头颈部感染致坏死性纵隔炎九例.中华口腔医学杂志，2009, 44(10)：619-620.
22.	罗立峰，程庆书.下行性坏死性纵隔炎的诊断与治疗.中国胸心血管外科临床杂志，2009, 16(5)：392-395.

1. 　Singhal P, Kejriwal N, Lin Z, et al. Optimal surgical management of descending necrotising mediastinitis： our experience and review of literature. Heart Lung Circ, 2008, 17(2)：124-128.
2. 　Iwata T, Sekine Y, Shibuy K, et al. Early open thoracotomy and mediastinopleural irrigation for severe descending necrotizing mediastinitis. Eur J Cardiothorac Surg, 2005, 28(3)：384-388..
3. 　Librizzi D, Mazzola E, Maragliano S, et a1. The descending necrotizing mediastinitis. G Chir, 2008, 29(8-9)：347-350.
4. 　Endo S, Murayama F, Hasegawa T, et al. Guideline of surgical management based on diffusion of descending necrotizing mediastinitis. Jpn J Thorac Cardiovasc Surg, 1999, 47( 1)：14-19.
5. 　Kaira K, Yasuoka H, Ichikawa T, et al. Descending necrotizing mediastinitis after upper gastrointestinal endoscopy. Endoscopy, 2007, 39( Suppl 1)：e29.
6. 　王永功，侯明，刘青青,等. 牙源性坏死性纵隔炎. 华西口腔医学杂志, 2001, 19(5)：336-337.
7. 　王建立.牙源性下行性坏死性纵隔炎临床分析.中外医疗，2010,29（21）：94.
8. 　Pinto A, Scaglione M , Scuderi MG, et al. Infections of the neck leading to descending necrotizing mediastinitis： Role of multi-detector row computed tomography. Eur J Radiol, 2008, 65(3)：389-394.
9. 　史向阳,井松,赵文刚,等.下行性坏死性纵隔炎的诊治及护理.中国实用护理杂志：下旬版，2005，21(6)：38.
10. 　Estrera AS, Landay MJ, GrishamJM, et al. Descending necrotizing mediastinitis. Surg Gynecol Obstet, 1983, 157(6)：545-552.
11. 　Righini CA, Motto E, Ferretti G, et al. Diffuse cervical cellulites and descending necrotizing mediastinitis. Ann Otolaryngol Chir Cervicofac, 2007, 124(6)：292-300.
12. 　Ghimire A, Bhattarai M, Kumar M, et al. Descending necrotizing mediastinitis： a fatal complication of neglected esophageal foreign body. Kathmandu Univ Med J (KUMJ), 2007, 5(1)：98-101.
13. 　徐富仁，辛定一. 急性感染性纵隔炎的诊断和治疗(25例报告).中华胸心血管外科杂志,1994, 10(2)：132-133,.
14. 　刘晶春，刘钢. 下行性坏死性纵隔炎合并右上肺感染1例分析. 中国误诊学杂志, 2008, 8(12)：3006-3007.
15. 　Roccia F, Pecorari GC, Oliaro A, et a1. Ten years of descending necrotizing mediastinitis： management of 23 cases. J Oral Maxillofac Surg, 2007, 65(9)：1716-1724.
16. 　Chen KC, Chen JS, Kuo SW, et al. Descending necrotizing mediastinitis：a 10-year surgical experience in a single institution. J Thorac Cardiovasc Surg, 2008, 136(1)：191-198.
17. 　上官诚芳，吴继昌，王士礼，等.严重颈深部感染引发下行性坏死纵隔炎1例.临床耳鼻喉头颈外科杂志, 2009, 7(23)：665-666.
18. 　Harar RP, Cranston C, Warwick-Brown N. Descending necrotizing mediastinitis： report of a case following steroid neck injection.J Laryngol Otol,2002, 116(10)：862-864.
19. 　Nikolaos ND, Apostolakis EE, Marangos MN, et a1. A less invasive management of post-thyroidectomy descending necrotizing mediastinitis is feasible：a case report and literature review. Med Sci Monit, 2007, 13(7)：CS83-87.
20. 　Caputo FJ, Magnotti LJ, Hauser CJ, et a1. Descending necrotizing mediastinitis： unique complication of central venous catheterization. Surg Infect(Larchmt), 2007, 8(6)：61l-614.
21. 　林崇翔，丁熙，麻益可，等.头颈部感染致坏死性纵隔炎九例.中华口腔医学杂志，2009, 44(10)：619-620.
22. 　罗立峰，程庆书.下行性坏死性纵隔炎的诊断与治疗.中国胸心血管外科临床杂志，2009, 16(5)：392-395.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Diagnosis and Therapy of Patients with Descending Necrotizing Mediastinitis

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