深頸部膿瘍から縦隔膿瘍へ進展した5例

―起因菌と治療法に関する考察―

抄録

Five cases of mediastinal abscess complicated with deep neck abscess were treated in our department, and clinically analyzed. The primary etiology was suggested as an odontogenic lesion in three cases, and unknown in two cases. All cases immediately underwent surgical drainage of the involved cervical region and mediastinum by a team of otolaryngologists and thoracic surgeons. The form of mediastinal drainage was a standard posterolateral thoracotomy in two cases, subxyphoid excision in two, and the cervical approach alone in one. All five cases survived, though in one case, in whom mediastinal drainage via the subxyphoid approach was performed as the primary operation, a second operation was required via thoracoscopic drainage. Anaerobic bacteria were identified in four cases, and Streptococcus anginosus, one of the Streptococcus milleri group being a common inhabitant of the mouth and gastrointestinal tract, was isolated from all five cases. The S. milleri group should be recognized as a major pathogen in severe deep neck infection and mediastinitis. The form of the surgical drainage of the mediastinum should be selected on the basis of both the severity and the extension of the abscess. The use of thoracoscopy enables more effective and less invasive surgery for the management of mediastinitis.