Retrospective Investigation Of Descending Necrotizing Mediastinitis

Objective:Our present study was to investigate the epidemiological characteristics, the risk factors that may affect the treatment, clinical manifestations, imaging features of descending necrotizing mediastinitis (DNM) patients, and to explore the effective treatment of descending necrotizing mediastinitis.Material and Methods:(1) Subjects:60 patients diagnosed with DNM and treated in Shanghai Ninth People's Hospital between January 2008 and September 2014.(2) Methods:To study the epidemiological feature of DNM, the retrospective analysis of medical history data of 60 patients with DNM was used in this study. In our present study, some factors was considered to be involved with the treatment outcome which included age, gender, white blood cell number, body temperature on admission, diabetes mellitus, the time between developing clinical signs and being treated, and whether using anti-anaerobic in early stage of DNM. By using a comprehensive analysis of the imaging diagnosis, treatment principles and the treatment outcome of different groups, we tried to confirm the risk factors which may extend the DNM course, to clarify the cause of infection of DNM, hoped to improve the cognition and experience in diagnosis and treatment of the disease in further clinic practice.(3) Statistics:In our retrospective study, multiple stepwise regression analysis was used by. All the statistical analysis was conducted with the SPSS19.0 software. While P was less than 0.05, it was considered statistically significant. When P< 0.01, it was considered significant difference.Results:(1) The findings concluded by the distribution proportions of DNM with different factors involved were showed as follow. People over the age of 60 is a sufferer. The male to female ratio of DNM was 6.5:1. According to the profession distributions in our study, farmer was the most affected profession in proportion (56.7%); The most common cause of DNM was induced by odontogenic infection (80%).(2) There were no significant differences between treatment courses of DNM patients with different genders or white blood cell counts (P>0.05). There were significant differences between the treatment courses of DNM patient with different ages, the time between developing clinical signs and being treated, body temperature, whether accompanied by diabetes, and whether using anti anaerobic in early stage of DNM (P<0.01), thus these factors were considered as risk factors of DNM. According to the results of multiple stepwise regression analysis, patients with different ages, whether accompanied with diabetes and the time between developing symptoms and being treated had an impact on the treatment course of DNM. Since the value of multiple factor B of that whether accompanied with diabetes was the highest, it was indicated that diabetes may have a great effect on prolonging the treatment course of DNM.Conclusions:(1) DNM epidemiological characteristics were that:Males were more susceptible to DNM. The main population of the DNM onset was the elderly over the age of 60. The most common profession was the farmer. The largest cause of DNM was induced by odontogenic infection.(2) Risk factors which may have an impact on the treatment course were that: age, the time between developing clinical signs and being treated, body temperature, whether accompanied by diabetes, whether using anti-anaerobic in early stage. Accompanying with diabetes was the main risk factor which may effect the treatment outcome of DNM.(3) Clinic opinions and suggestions:Timely diagnosis, emergency wide surgical drainage, using anti-infection methods actively, and complete removal and drainage of necrotic tissue and pus were the effective treatment of DNM.