重症口腔颌面头颈部多间隙感染临床分类探讨

doi:10.19438/j.cjoms.2023.02.004

摘要/Abstract

摘要： 目的： 探讨一种新的口腔颌面头颈部多间隙感染临床分类方法。方法： 回顾攀枝花市中心医院2015年7月—2022年3月采用全麻手术治疗的120例重症口腔颌面头颈部多间隙感染患者的临床及影学资料,探讨一种新的分类方法。采用SPSS 17.0软件包对数据进行统计学分析。结果： 重症口腔颌面头颈部多间隙感染可分为5类。Ⅰ类82例（68.33%）,感染集中在舌骨-颧弓平面范围,通过下颌下切口能充分引流各间隙感染;Ⅱ类13例（10.83%）,感染向上波及颞深间隙,需行下颌下及颞部2个切口充分引流;Ⅲ类14例（11.67%）,感染向下波及锁骨以上的颈下部间隙,需行下颌下及锁骨上切口充分引流;Ⅳ类5例（4.17%）,感染波及颞部到锁骨上范围,需结合下颌下、颞部及锁骨上多个切口引流;Ⅴ类6例（5%）,感染突破锁骨平面波及纵隔、胸腔,必须联合心胸外科行纵隔及胸腔引流。从Ⅰ类到Ⅴ类患者病情逐渐加重,治疗难度逐渐递增,风险逐渐提高,平均ICU监护时长、住院时长、住院花费及抗菌药费用等医疗资源消耗也逐渐增加（P<0.0001）。结论： 重症口腔颌面头颈部多间隙感染危及生命,多学科联合是治疗的前提。对该病进行合理分类,是精准化、规范化治疗的基础,广泛彻底的脓肿切开引流联合有效的辅助冲洗是治疗的关键。

关键词: 口腔颌面头颈部, 重症多间隙感染, 牙源性感染, 分类, 治疗

Abstract: PURPOSE: To explore a new clinical classification method for oromaxillofacial head and neck multi-space infections. METHODS: The clinical and radiographic data of patients with severe oromaxillofacial head and neck multiple-space infections treated under general anesthesia in Panzhihua Central Hospital from July 2015 to March 2022 were retrospectively analyzed, and a new classification method was proposed. SPSS 17.0 software package was used for data analysis. RESULTS: Severe oromaxillofacial head and neck multi-space infections can be divided into five types. Type Ⅰ(n=82, 68.33%), the infection was concentrated between the hyoid plane and the zygomatic arch plane, and the infection in each space could be fully drained through the submaxillary incision. Type Ⅱ(n=13, 10.83%), the infection spread upward to the deep temporal space, and two submandibular and temporal incisions were needed for full drainage. Type Ⅲ(n=14, 11.67%), the infection spread down to the lower cervical space above the clavicle, and full drainage through submaxillary and supraclavicular incision was needed. Type Ⅳ(n=5, 4.17%), the infection spread from the temporal to the supraclavicle area, and multiple submaxillary, temporal and supraclavicle incisions were needed for drainage. In 6 cases (5%) of type Ⅴ, the infection broke through the clavicular plane and spread to the mediastinum and thorax. Mediastinum and thorax drainage must be combined with cardiothoracic surgery at the same time. From typeⅠto typeⅤ, the general condition gradually worsened, the treatment difficulty and risk gradually increased, and the consumption of medical resources such as average ICU monitoring time, hospitalization time, hospitalization cost and antibacterial drug cost also gradually increased (P<0.0001). CONCLUSIONS: Severe oromaxillofacial head and neck multi-space infections are life-threatening, and multidisciplinary therapy is the premise of treatment. Reasonable classification of the disease is the basis of accurate and standardized treatment. Extensive incision and drainage combined with effective auxiliary irrigation technology is the key to treatment.

Key words: Oromaxillofacial head and neck region, Life-threatening multiple space infection, Odontogenic infection, Classification, Treatment

中图分类号:

R782.3

邱银秀, 代天国, 徐波, 程进强, 刘忠龙. 重症口腔颌面头颈部多间隙感染临床分类探讨[J]. 中国口腔颌面外科杂志, 2023, 21(2): 125-130.

QIU Yin-xiu, DAI Tian-guo, XU Bo, CHENG Jin-qiang, LIU Zhong-long. A new clinical classification of severe oromaxillofacial head and neck multi-space infections[J]. China J Oral Maxillofac Surg, 2023, 21(2): 125-130.

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