入院加療を行った深頸部膿瘍例の検討

Abstract

We reviewed 42 cases of deep neck abscess drained surgically or treated conservatively between February 2001 and August 2008, based on age, gender, primary focus, main symptom, abscess location, systemic disease, pathogenic bacteria, hospital treatment, hospitalization length, complications and long-term hospitalization. Of the 42, 26 were men and 16 women aged 14 to 80 (central age: 54.5 years). Abscess was caused most by tonsil inflammation (38.1%). Main symptom were sore throat (54.8%) and neck swelling (35.7%). Abscesses were found in the supra- and infrahyoid region in 30 cases and extended to the mediastinum in 2. Of the 42, 14 (33.3%) had hypertension and 11 (26.2%) diabetes mellitus (DM). Inflammation was due to aerobic bacteria (mainly Streptococcus milleri) in 23 cases (54.8%) and to anaerobic bacteria (mainly Peptostreptococcus) in 11 cases (26.2%). Flexible fiberscopic examination was important in evaluating pharyngeal and laryngeal mucosal disorders and enhanced computed tomography was useful in both diagnosis and postoperative observation. Of the 42, 38 required surgical drainage and 4 were cured using needle aspiration and antibiotics. Of the 38 undergoing surgery-tracheostomy was required in 22. Hospitalization for those with tracheostomy and DM was longer than in those without these factors. Complications included 2 cases each of, mediastinal abscess, sepsis, disseminated intravascular coagulation (DIC), acute renal failure, severe pneumonia, upper digestive tract bleeding and swallowing disorder. Early surgical drainage and intravenous antibiotic administration are thus essential for treating deep neck abscesses.