魯特維格氏咽峽炎－20年病例之分析

背景：魯特維格氏咽峽炎(Ludwig's angina)爲口腔底部的急性蜂窩組織炎，若未及時診斷並給予適當治療，有導致呼吸道阻塞甚至死亡之可能。回顧國內文獻，罕有單一醫院長時間大病例數之回溯性文獻報告，特別分析探討高雄榮總近20年之魯特維格氏咽峽炎病例。方法：以回溯病歷方式，收集本院自1991年1月至2010年4月，排除病理報告爲惡性者後，電腦斷層及臨床症狀診斷爲魯特維格氏咽峽炎共有33名。針對性別、年齡、住院天數、病因、症狀、是否接受手術、細菌培養結果、抗生素的使用等做分析。以Student's t-test進行統計分析。結果：33例中，男性22例，女性11例，平均年齡52.2歲。平均住院天數13.8天。臨床症狀(Symptom)以頸部腫脹(97%)最爲常見，表徵(sign)以頦下(submental)部腫脹(97%)最爲常見。齒源性病因最多，佔13例(39.3%)。有呼吸困難佔7例(21.2%)，其中4例(12.1%)經內視鏡由鼻部插管，1例(3.0%)行氣切。牙部手術有6例(18.2%)，頦下部的切開及引流有12例(36.3%)。無死亡病例(0%)。統計發現影響住院天數變長的預後因子爲：女性、年紀大於50歲、頦下部曾切開引流、曾插管或氣切。結論：一旦確定診斷爲曾特維格氏咽峽炎，維持呼吸道的暢通最爲重要。給予適當的靜脈抗生素注射，以及必要時之拔牙或切開引流，可減少併發症及降低死亡率。

關鍵字

魯特維格氏咽峽炎；預後因子；治療

並列摘要

BACKGROUND: Ludwig's angina is a rapidly spreading cellulitis involving the mouth floor, and may cause airway obstruction or even death without early diagnosis and appropriate treatment. A retrospective study of Ludwig's angina at one hospital over a long period of time is rare in Taiwan's scientific literature. Here we reported an analysis and investigation of Ludwig's angina at Kaohsiung Veteran General Hospital over the last 20 years.METHODS: A retrospective chart review from January 1991 to April 2010 was carried out, and any patients with malignant pathology proved by operation were excluded. A total of 33 patients diagnosed with Ludwig's angina by neck CT scan, symptom and sign were enrolled. We analyzed the patient's gender, age, hospitalization days, etiology, symptoms, whether an operation was carried out, culture reports, and antibiotics use among these 33 patients. A Student's t-test was used for the data analysis.RESULTS: Among 33 patients enrolled, 22 patients were male and 11 patients were female. Meanage was 50.2, and mean hospitalization days was 13.7 days. Most common symptom was neck swelling (97%), and most common sign was submental swelling (97%). 7 (2l%) patients had the symptom of dyspnea. 4 patients were intubated through fiber nasolaryngoscope, and 1 patient was treated with tracheostomy. 6 (18%) patients received dental surgery, and 12 (36%) patients received submental incisional drainage. No death was noted (0%). Prognostic factors such as female, age＞50, ever submental incisional drainage, and ever intubation will make hospitalization days longer.CONCLUSION: Maintaining the patency of patient's airway is extremely important after we made the diagnosis of Ludwig's angina. Appropriate intravenous antibiotics, and tooth extraction or submental incisional drainage if necessary can reduce complication rate and motality rate.

並列關鍵字

Ludwig's angina ； prognostic factor ； treatment

國際替代計量

魯特維格氏咽峽炎－20年病例之分析

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