• Journal of Chest Surgery
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• 제35권2호
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• pp.161-165
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• 2002

하행 괴사성 종격동염은 대부분 경부 부위의 농양으로 시작하여 종격동으로 파급되는 매우 치명적인 질환이며 저자에 따라 25∼40%의 사망률을 보고하고 있다. 빠른 진단과 적절한 수술적 치료가 중요하며 수술적 치료의 방법에는 아직 여러 가지 방법들이 보고되고 있지만 농양의 완전한 배농이 특히 중요하다고 보고하고 있다. 배농술은 경부 절개를 통한 배농과 함께 흉부 내의 종격동 배농술이 필요하며 종격동 배농술은 대부분 개흉술을 통하여 시행되어 왔으나 개흉술에 따른 합병증과 수술부위의 감염 등이 술후 이환율을 증가시키는 원인이 될 수 있다. 반면에 흥강경을 이용한 배농은 경부 배농술 및 흉부 배농술을 동시에 시행할 수 있으며 좋은 수술시야를 보여주고 술후 환자의 회복이 빨라 하행 괴사성 종격동염의 좋은 치료 방법이라 생각된다.

• Journal of Chest Surgery
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• 제56권1호
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• pp.35-41
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• 2023

Background: We analyzed our experience with descending necrotizing mediastinitis (DNM) treatment and investigated the efficacy of video-assisted thoracoscopic surgery (VATS) for mediastinal drainage. Methods: This retrospective analysis included patients who underwent surgical drainage for DNM at our hospital from 2005 to 2020. We analyzed patients' baseline characteristics, surgical data, and perioperative outcomes and compared them according to the mediastinal drainage approach among patients with type II DNM. Results: Twenty-five patients (male-to-female ratio, 18:7) with a mean age of 54.0±12.9 years were enrolled in this study. The most common infection sources were pharyngeal infections (60%). Most patients had significantly increased white blood cell counts, elevated C-reactive protein levels, and decreased albumin levels on admission. The most common DNM type was type IIB (n=16, 64%), while 5 and 4 patients had types I and IIA, respectively. For mediastinal drainage, the transcervical approach was used in 15 patients and the transthoracic approach (VATS) in 10 patients. The mean length of hospital stay was 26.5±23.8 days, and the postoperative morbidity and in-hospital mortality rates were 24% and 12%, respectively. No statistically significant differences were found among patients with type II DNM between the transcervical and VATS groups. However, the VATS group showed shorter mean antibiotic therapy duration, drainage duration, and hospital stay length than the transcervical group. Conclusion: DNM manifested as severe infection requiring long-term inpatient treatment, with a mortality rate of 12%. Thus, active treatment with a multidisciplinary approach is crucial, and mediastinal drainage using VATS is considered relatively safe and effective.

• 대한기관식도과학회지
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• 제15권2호
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• pp.64-70
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• 2009

Descending necrotizing mediastinitis(DNM) can occur as a complication of oropharyngeal and cervical infections that spread to the mediastinum via the cervical spaces. Delayed diagnosis and inadequate mediastinal drainage through a cervical or minor thoracic approach are the primary causes of a high mortality rate. Therefore, We emphasize that aggressive and emergent mediastinal drainage by surgical approach is most important method of DNM treatment. We studied 5cases diagnosed as DNM from 2005 through 2007. All patients underwent emergent surgical drainage of deep neck infection combined with mediastinal drainage through a thoracic approach. Primary oropharyngeal infection lead to DNM in four cases(80%) and odontogenic abscess in one case(20%). The outcomes were favorable 5patients. Overall mortality rate was 0%. The time interval from diagnosis based on manifestation of initial symptoms(oral or pharyngolaryngeal area) to surgical intervention was $7.4{\pm}4.2$days. One patient required reoperation due to remnant mediastinal abscess and pericardial effusion. Early diagnosis and emergent combined drainage with neck and chest incisions, together with broad spectrum intravenous antibiotics, should be considered standard care for this disease. And intensive postoperative care which it is continuous mediastinal irrigation and antibiotics use can significantly reduce the mortality rate.

• Journal of Chest Surgery
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• 제45권3호
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• pp.171-176
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• 2012

Background: Deep neck infections (DNI) can originate from infection in the potential spaces and fascial planes of the neck. DNI can be managed without surgery, but there are cases that need surgical treatment, especially in the case of mediastinal involvement. The aim of this study is to identify clinical features of DNI and analyze the predisposing factors for mediastinal extension. Materials and Methods: We reviewed medical records of 56 patients suffering from DNI who underwent cervical drainage only (CD group) and those who underwent cervical drainage combined with mediastinal drainage for descending necrotizing mediastinitis (MD group) from August 2003 to May 2009 and compared the clinical features of each group and the predisposing factors for mediastinal extension. Results: Forty-four out of the 56 patients underwent cervical drainage only (79%) and 12 patients needed both cervical and mediastinal drainage (21%). There were no differences between the two groups in gender (p=0.28), but the MD group was older than the CD group (CD group, $44.2{\pm}23.2$ years; MD group, $55.6{\pm}12.1$ years; p=0.03). The MD group had a higher rate of co-morbidity than the CD group (p=0.04). The CD group involved more than two spaces in 14 cases (32%) and retropharyngeal involvement in 12 cases (27%). The MD group involved more than two spaces in 11 cases (92%) and retropharyngeal involvement in 12 cases (100%). Organism identification took place in 28 cases (64%) of the CD group and 3 cases of (25%) the MD group (p=0.02). The mean hospital stay of the CD group was $21.5{\pm}15.9$ days and that of the MD group was $41.4{\pm}29.4$ days (p=0.04). Conclusion: The predisposing factors of mediastinal extension in DNI were older age, involvement of two or more spaces, especially including the retropharyngeal space, and more comorbidities. The MD group had a longer hospital stay, higher mortality, and more failure to identify causative organisms of causative organisms than the CD group.