摘要：  目的：总结牙源性下行性坏死性纵隔炎的临床表现、发病机制、诊断和治疗方法，以提高该病的早期诊断率及治愈率。方法：回顾分析了5例牙源性坏死性纵隔炎的临床资料，男2例，女3例，平均年龄54.6岁。病因分析，下颌智齿冠周炎3例，上、下颌磨牙根尖脓肿各1例。均据临床表现、脓液细菌培养、CT等检查明确诊断。积极采用经颈或联合颈胸手术切开引流，其中经颈切开引流3例，应用胸腔镜行胸部引流2例。同时进行全身抗感染、营养支持等治疗。结果：5例患者经及时手术和药物治疗，出院前复查胸部CT，显示纵隔恢复正常，均痊愈出院，住院时间23～51 d，平均29.2 d。结论：牙源性下行性坏死性纵隔炎的病情发展迅速，早期确诊、及时切开引流是治疗成功的关键。

关键词: 牙源性,  ,  , 下行性坏死性纵隔炎,  ,  , 外科引流,  ,  , 诊断,  ,  , 治疗

Abstract: Objective: To review and summarize the clinical characteristics and treatment outcomes of odontogenic descending necrotizing mediastinitis (ODNM). Methods: Five ODNM patients were retrospectively analyzed. 2 males and 3 females with a median age of 54.6 years. 3 patients had mandibular wisdom teeth pericoronitis and 2 patients had periapical abcess of molars. The diagnosis measures included clinical examination, CT scan, and bacteriological culture. Treatments consisted of antibiotic administration and aggressive transcervial(3 cases) and/or transthoracic surgical mediastinal drainage (2 cases) . Patients hospitalized from 23 to 51 days, and the average stay was 29.2 days.  Results:  All patients achieved satisfactory recovery. Conclusion: Diagnosis without delay and aggressive surgical mediastinal drainage are significant in control of ODNM.

Key words: odontogenic, descending necrotizing mediastinitis, surgery drainage； diagnosis； treatment

中图分类号: 

• R782.3