- 期刊
口腔癌引發頸部壞死性筋膜炎合併肺結核－病例報告
Cervical Necrotizing Fasciitis with Pulmonary Tuberculosis after Biopsy Oral Squamous Cell Carcinoma-A Case Report
摘要
在頭頸部的感染中，頭頸部壞死性筋膜炎是一種少見，但是非常嚴重的軟組織感染，細菌沿著頸部的筋膜造成大範圍的組織破壞，至於最後覆蓋於其上的皮膚壞死。此急症最大的特點就是其進展快速且在早期很難鑑別診斷，在最後代表頸部皮膚壞死的水泡或壞疽出現前，此感染可能已經造成呼吸道窘迫，甚至全身性的敗血性休克。若是感染進入胸縱膈腔造成胸縱膈腔炎，也能造成五成以上的死亡率。敗血性休克若是無法獲得控制，也會進一步造成多重器官衰竭導致病人死亡。病人即使逃過以上等併發症，也往往因為頸部皮膚大量的壞死而必須接受補皮的手術。本文報告一壞死性筋膜炎之病例，為右側頰癌及下顎牙齦癌切片後所引發的二次感染，並且在治療過程中同時發現病人有肺結核並加以治療。
並列摘要
Among head and neck infection, cervicofacial necrotizing fasciitis is a rare but fulminant infection of the soft tissues that can be fatal if not treated early. It spreads quickly along fascial planes causing extensive necrosis and sometimes eventual gangrene of the overlying skin. The low incidence of CNF and deceptive early clinical features make it very difficult to differentiate from other soft tissue infections. The infection may cause airway obstruction and septic shock early before the signs of skin necrosis. It can also spread from head and neck into the chest wall and mediastinum, and mediastinitis increases the mortality to more than 50%. The septic shock may eventually cause multiple organ failure and death if it is not under well medical control. Even though the patient escapes the above complications, he often has to receive reconstructive surgery due to large skin defect after debridement. We present a case of cervical necrotizing fasciitis originated from secondary infection of biopsy for R't buccal and mandibular gingival cancer. During the hospital course, pulmonary tuberculosis (TB) was also diagnosed and treated.