摘要
背景：深頸部感染較少發生在兒童，常因幼童主訴不明或症狀不明顯，而容易延誤診斷及治療，本文希望藉由本院的治療經驗及病歷的分析，探討正確的診斷方法及治療方針，以避免致命的併發症產生。 方法：自1994年1月至2000年1月間，針對20名深頸部感染接受住院治療的兒童，以回溯性分析探討其發生的原因、臨床徵狀、診斷方法、細菌學、抗生素治療原則及手術治療的時機。 結果：20名患者中，11名為男性，9名為女性；年齡分佈自6個月至18歲，平均年齡8.6歲，平均住院天數8天；最常見的深頸部感染症狀為頸部腫痛（95%）及發燒（80%），最常見致病原因為上呼吸道感染及牙齒發炎。病灶最常見於頜下間隙有13例（59%）、扁桃腺周圍間隙4例（18%）、咽後間隙3例（14%）、咽旁間隙2例（9%），其中同時感染咽後及咽旁間隙者有2例（13%），併發上呼吸道阻塞者1例，併發上呼吸道阻塞及縱膈腔炎者2例。而在12例病患培養出的15種細菌中，以嗜氧菌（12/15）最常見。4例（20%）僅接受抗生素治療，其餘16例（80%）除抗生素治療外，並接受外科切開引流（14/16）或針抽吸（2/16）治療。有3例因上呼吸道阻塞接受氣管內插管。所有病患均治癒出院，追蹤迄今均無復發。 結論：疑似深頸部感染的兒童，應注意併發上呼吸道阻塞的可能性。而電腦斷層攝影可確立感染範圍、位置及膿瘍存在與否。治療除給予廣效抗生素及靜脈輸液外，一旦膿瘍形成、同時存在兩個以上間隙感染或併發症產生時，應立即予以外科引流。
並列摘要
BACKGROUND: Deep neck infection is a potentially life-threatening disease and is rarely seen in children. Correct diagnosis and treatment for children with deep neck infections is easily delayed due to frequently obscure chief complaints and symptoms. To minimize the occurrence of fatal complications, appropriate diagnostic and therapeutic modalities are suggested after review of cases at our hospital. METHODS: Twenty children diagnosed with deep neck infections treated between January 1994 and January 2000 were retrospectively reviewed. The clinical symptoms and signs, etiology, diagnostic methods, bacteriology, medical antibiotic treatment and timing of surgical intervention were tabulated. RESULTS: Twenty children had been diagnosed with deep neck infections. Eleven were male and nine female. Their ages ranged between six months and 18 years with a mean age of 8.6 years. The most common symptoms at the time of presentation were painful swelling of neck (95%) and fever (80%). Typical etiologies were upper respiratory tract and odontogenic infections. Submandibular space infections were the most common (13/20), followed by peritonsillar (4/20), retropharyngeal (3/20), and parapharyngeal (2/20) space infections. Two spaces, retropharyngeal and parapharyngeal, were involved synchronously in two patients. Complications included upper airway obstruction in one of the patients and mediastinitis in two. Twelve of the 15 bacterial isolates recovered from the 12 patients were aerobic. Four patients received intravenous antibiotics alone. In addition to antibiotic treatment, 14 patients underwent surgical incision and drainage, and two underwent needle aspiration of pus. Three patients suffering upper airway obstruction as a complication underwent endotracheal intubation. All patients had complete resolution of disease without sequelae or recurrence. CONCLUSIONS: Upper airway obstruction should always be ruled out if a child is suspected of having a deep neck infection. Endoscopic and imaging studies should then be performed. CT scans provide important information regarding abscess size, location, and relative positions of the great vessels and airway. Parenteral broad spectrum antibiotics should be given and surgical intervention should be initiated in cases of abscess formation, multiple spaces involvement, or in the presence of complications.