入院加療を行った扁桃周囲膿瘍症例の検討

抄録

A retrospective study was conducted on 161 patients with peritonsillar abscess from July 2007 to June 2015 (111 males and 50 females; aged 11 to 86 years old, median age 41 years). All the patients were hospitalized and treated with drainage by incision for the abscess and intravenous administration of antibiotics. Out of the 161 patients, 83 (51.5%) were affected on the right side, 74 (46%) on the left and 4 (2.5%) on the bilateral. 137 (85.1%) patients were diagnosed as superior type and 24 (14.9%) as inferior type. In the blood test on the first day, number of white blood cells (WBC) ranged from 4600 to 26450 (median 12900) and C-reactive protein (CRP) ranged from 0.35 to 28.9 (median 7.98 mg/dl). Laryngeal edema was complicated in 35 (21.7%) of 161 patients. All the patients were treated with intravenous administration of either PIPC 2 g + CLDM 0.6 g (n = 74), ABPC/SBT 1.5 g + CLDM 0.6 g (n = 39), or ABPC/SBT 3 g (n = 31) twice a day. Decrease rates in WBC of patients with ABPC/SBT 1.5 g + CLDM 0.6 g or those with ABPC/SBT 3 g twice a day were significantly higher than those with PIPC 2 g + CLDM 0.6 g twice a day (p < 0.05). Age, CRP and percentage of laryngeal edema in the inferior type were significantly higher than those in the superior type (p < 0.05). Of the 24 patients of the inferior type of peritonsillar abscess, 12 (50%) patients cannot be drained with incision but cured with antibiotics and steroid. Four (16.7%) patients underwent abscess tonsillectomy under general anesthesia the next day after admission. These findings suggest that treatment with ABPC/SBT and drainage by incision is effective for peritonsillar abscess. The inferior type of peritonsillar abscess needs more intensive treatments including abscess tonsillectomy.