頸部の再搔爬で鎖骨下静脈を損傷した降下性壊死性縦隔炎の1例

Descending Necrotizing Mediastinitis with Subclavian Vein Injury due to Cervical Re-debridement：Report of a Case

はじめに　降下性壊死性縦隔炎（descending necrotizing mediastinitis：DNM）は，口腔・咽頭感染が気管前，頸部血管周囲，後咽頭などを経由して縦隔へ下降して発症するまれな縦隔炎で，かつては死亡率40％程度とされていた．近年，積極的な外科的ドレナージにより死亡率は数％程度まで改善している．われわれは，頸部の再搔爬時に鎖骨下静脈から出血をきたし，胸鎖乳突筋離断，胸骨L字切開で出血点を明らかにしてタコシール（CSLベーリング社）で止血しえたDNMの1例を経験したので報告する．

A 58-year-old man was admitted to our hospital with fever and neck swelling after dental treatment. He was diagnosed with a cervical abscess and underwent cervical abscess drainage, but 1 week later he developed descending necrotizing mediastinitis and was referred to our department. He underwent mediastinal and pleural drainage, but neck abscess was recured, Re-debridment of the neck abscess resulted in bleeding from right subclavian vein. The bleeding was successfully stopped with TacoSeal after L-shaped sternotomyand dissection of sternocleidomostoid muscle.