小儿头颈部软组织坏死性感染：1例报告及系统回顾。

IF 1.3 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology Pub Date : 2025-10-08 DOI:10.1016/j.ijporl.2025.112586

Carlos Khalil , Jenny Xiao , Eduardo Gus , Evan J. Propst , Nikolaus E. Wolter , Jennifer M. Siu

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引用次数: 0

摘要

儿童头颈部坏死性软组织感染（NSTI）是一种罕见的疾病（每年每10万名儿童中有0.08例），但危及生命，需要及时诊断和治疗。本系统综述旨在描述一个病例报告，并综合当前文献，以确定这种罕见疾病的主要临床特征、管理策略和预后。方法：检索Medline （Ovid）、Embase、Cochrane图书馆和Web of Science，检索描述头颈部NSTI患儿的文章。提取患者因素、微生物学、治疗和结果的数据。结果：从47篇文献中鉴定出56例小儿头颈部NSTI。平均发病年龄为5.2±5.3岁（61%为男性）。平均发病时间为3.2±4.4天。最常见的首发症状包括皮肤覆盖红斑（n = 37/ 56,66 %）、水肿（n = 36/ 56,64 %）、发热（n = 31/ 56,55 %）、疼痛（n = 19/ 56,34 %）、心动过速（n = 16/ 56,29 %）、低血压（n = 15/ 56,27 %）和皮肤坏死（n = 8/ 56,14 %）。头颈部NSTI受累的解剖位置最常见于颈面（45/ 56,80 %）、颅颈（8/ 56,14 %）和胸颈（7/ 56,13 %）。在已知的病因中，最常见的是外伤/医源性（n = 11/ 56,20 %）和牙源性（n = 7/ 56,13 %）。41%的病例病因不明（23/56）。59%的病例（n = 33/56）在首次手术前进行影像学检查，计算机断层扫描（CT）是最常见的影像学检查方式（43%,24/56）。首次手术清创平均时间为1.3±3.4天。最常见的微生物是A群链球菌（n = 13/ 56,23 %）、多微生物（n = 11,20 %）、葡萄球菌（n = 6/ 56,11 %）和假单胞菌（n = 6/ 56,11 %）。近一半（n = 19/ 41,46 %）的病例需要一次以上的手术清创，总体平均清创次数为2.3±2.0次。平均住院时间为30±25天，总死亡率为5%（3/56）。结论：小儿头颈部NSTI是一种罕见的危及生命的疾病，需要早期识别和积极治疗。及时诊断、及时手术清创和多学科治疗对于改善这一弱势人群的预后至关重要。

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Pediatric necrotizing soft tissue infections of the head and Neck: A case report and systematic review

Introduction

Pediatric necrotizing soft tissue infection (NSTI) of the head and neck is a rare (0.08 per 100,000 children per year) but life-threatening condition requiring prompt diagnosis and treatment. This systematic review aims to describe a case report and synthesize the current literature to identify key clinical features, management strategies, and outcomes of this rare condition.

Methods

Medline (Ovid), Embase, the Cochrane library, and Web of Science were searched for articles that described pediatric patients who had NSTI of the head and neck. Data on patient factors, microbiology, treatment, and outcomes were extracted.

Results

56 cases of pediatric NSTI of the head and neck were identified from 47 articles. Mean age of occurrence was 5.2 ± 5.3 years (61 % male). Mean time to presentation was 3.2 ± 4.4 days. Most common initial presenting symptoms included overlying skin erythema (n = 37/56, 66 %), edema (n = 36/56, 64 %), fever (n = 31/56, 55 %), pain (n = 19/56, 34 %), tachycardia (n = 16/56, 29 %), hypotension (n = 15/56, 27 %), and skin necrosis (n = 8/56, 14 %). Anatomical location of head and neck NSTI involvement was most commonly reported in cervicofacial (45/56, 80 %), craniocervical (8/56, 14 %), and thoracocervical (7/56, 13 %). Of known aetiologies, the most frequently reported were traumatic/iatrogenic (n = 11/56, 20 %) and odontogenic (n = 7/56, 13 %). In 41 % of cases the etiology of NSTI was unknown (23/56). Imaging was performed prior to the initial OR in 59 % of cases (n = 33/56) and computed tomography (CT) was the most common imaging modality (43 %, 24/56). Mean time to first surgical debridement was 1.3 ± 3.4 days. The most frequently identified microorganism was Group A Streptococcus (n = 13/56, 23 %), polymicrobial (n = 11, 20 %), Staphylococcus (n = 6/56, 11 %), and Pseudomonas (n = 6/56, 11 %). Almost one half (n = 19/41, 46 %) of the cases required more than one surgical debridement, and the overall average number of debridements was 2.3 ± 2.0. Mean length of hospital stay was 30 ± 25 days and overall mortality was 5 % (3/56).

Conclusion

Pediatric NSTI of the head and neck is a rare, life-threatening condition requiring early recognition and aggressive management. Prompt diagnosis, timely surgical debridement, and a multidisciplinary approach are critical to improving outcomes in this vulnerable population.

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来源期刊

International journal of pediatric otorhinolaryngology 医学-耳鼻喉科学

CiteScore

3.20

自引率

6.70%

发文量

276

审稿时长

62 days

期刊介绍： The purpose of the International Journal of Pediatric Otorhinolaryngology is to concentrate and disseminate information concerning prevention, cure and care of otorhinolaryngological disorders in infants and children due to developmental, degenerative, infectious, neoplastic, traumatic, social, psychiatric and economic causes. The Journal provides a medium for clinical and basic contributions in all of the areas of pediatric otorhinolaryngology. This includes medical and surgical otology, bronchoesophagology, laryngology, rhinology, diseases of the head and neck, and disorders of communication, including voice, speech and language disorders.