咽後膿瘍併發縱隔腔與肋膜腔積膿－病例報告

Retropharyngeal Abscess Complicated by Mediastinal and Pleural Empyema - Case Report

蔡政谷(Cheng-Ku Tsai) ； 翁炳坤(Ping-Kun Weng) ； 許正義(Jane-Yi Hsu) ； 黃健郎(Chien-Lang Huang) ； 王興萬(Hsing-Won Wang)

《中華民國耳鼻喉科醫學雜誌》 35卷2期 (2000/03) Pp. 124-127

https://doi.org/10.6286/2000.35.2.124

摘要

深頸部感染為不少見且死亡率不低的疾病，尤其合併縱隔腔積膿時，易引發敗血症，死亡率高達40%以上，對於耳鼻喉科與胸腔外科醫師而言，頗具挑戰性。本文提出1名47歲之男性病例，由於咽後膿瘍向下蔓延，合併縱隔腔及肋膜腔積膿，經胸腔外科醫師插入胸管引流，再由本科醫師進行頸部擴創術及引流頸部膿瘍，並施行氣管內插管以維持呼吸道通暢，頸部膿瘍之細菌培養為溶血性鏈球菌及金黃色葡萄球菌，治療3週後拔除胸管，病人在住院第37天情況穩定下出院。

關鍵字

咽後膿瘍 ； 縱隔腔積膿 ； 肋膜腔積膿

並列摘要

Deep neck infection is nor uncommon. Its mortality rate is relatively high. The mortality rate may be up to 40% when it is complicated by mediastinal empyema and sepsis. The disease is a challenge to both the otolaryngologist and thoracic surgeon. This report presents a case of retropharyngeal abscess complicated by mediastinal and pleural empyema. We consulted a thoracic surgeon to insert chest tubes for immediate drainage. Debridement and drainage of the cervical abscess and endotracheal intubation to maintain a patent airway were also performed. The pus culture revealed both Hemolytic Strepto-coccus and Staphylococcus aureus. Antibiotic therapy with clindamycin and gentamycin was given. The chest tubes were removed after the empyema resolved. The patient was discharged in stable condition on the 37th day after admission. Correct diagnosis and early treatment of deep neck infection are the best ways to prevent mediastinal and pleu-ral complications.

並列關鍵字

retropharyngeal abscess ； mediastinal empyema ； pleural empyema