{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T21:59:24Z","timestamp":1777931964377,"version":"3.51.4"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"S 01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Zentralbl Chir"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>\n          Einleitung Die deszendierende nekrotisierende Mediastinitis (DNM) ist ein seltener, aber sehr schwerwiegender septischer Zustand, der durch das \u00dcbertreten einer Infektion aus dem Hals ins Mediastinum hervorgerufen wird. Verz\u00f6gerung in der Diagnostik und ein unzureichender chirurgischer Eingriff bedeuten f\u00fcr den Kranken einen lebensbedrohenden Zustand.<\/jats:p><jats:p>\n          Material und Methode Wir beurteilen retrospektiv eine Patientengruppe, bei der in unserer Abteilung die DNM durch eine Drainage in den letzten 10 Jahren (2010\u200a\u2013\u200a2019) therapiert wurde. Bei allen Patienten war eine der folgenden Mediastinumdrainagen erforderlich: zervikomediastinale, mediastinothorakale oder zervikomediastinothorakale \u201eRendevouz\u201c-Drainage (ZMT-D). Wir beurteilten in der Gruppe die Infektionsquelle, den mikrobiologischen Kultivierungsbefund, die Art der Mediastinumdrainage, den Krankenhausaufenthalt, die Beatmungsdauer und die Laborentz\u00fcndungsparameter.<\/jats:p><jats:p>\n          Ergebnisse Insgesamt wurden 22 Patienten mit DNM behandelt, 14 M\u00e4nner und 8 Frauen im Alter von 23 bis 85 Jahren, Durchschnittsalter 54,1 Jahre. Durch weitere Ausbreitung der Entz\u00fcndung musste in 8 F\u00e4llen der zervikomediastinalen Drainage eine der transthorakalen Drainagemethoden folgen. Letztendlich wurde in 8 F\u00e4llen von Mediastinitis eine Sp\u00fcldrainage aus dem Halszugang, in 6 F\u00e4llen durch Thorakotomie und in 8 F\u00e4llen durch die Sp\u00fcl-ZMT-D durchgef\u00fchrt. Die Art der Drainage wurde nach den ersten CT-Befunden ausgew\u00e4hlt, weitere Interventionen nach CT-Kontrollen w\u00e4hrend der Behandlung. Im Zusammenhang mit DNM starben 4 Patienten (Mortalit\u00e4t 18,2%). Bei 15 Patienten wurde eine Tonsillitis als Ursache einer DNM festgestellt, bei 6 Patienten eine odontogene Infektion und bei 1 Patient blieb die Ursache unklar. Obwohl wir die Methode immer individuell und die ZMT-D f\u00fcr die schwierigeren F\u00e4lle ausw\u00e4hlten, gab es keine statistisch signifikanten (p\u2009&lt;\u20090,05) Unterschiede\n\t\t\t\t\tzwischen den bewerteten Parametern. Im Vergleich waren der Krankenhausaufenthalt und die Beatmungsdauer bei der ZMT-D k\u00fcrzer als bei den anderen Drainagemethoden (nicht signifikant).<\/jats:p><jats:p>\n          Schlussfolgerung Insbesondere bei einer Infektion der distalen Bereiche des Mediastinums halten wir ZMT-D f\u00fcr eine ideale Art der Drainage. Es handelt sich um einen gen\u00fcgend radikalen Behandlungsansatz. Sowohl die Behandlungszeit als auch die Mortalit\u00e4t sind nach Einsch\u00e4tzung in unserer Gruppe trotz des Schweregrads der Erkrankung positiv ausgefallen.<\/jats:p>","DOI":"10.1055\/a-1346-0210","type":"journal-article","created":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T00:40:48Z","timestamp":1612399248000},"page":"S19-S25","source":"Crossref","is-referenced-by-count":2,"special_numbering":"S","title":["Deszendierende nekrotisierende Mediastinitis: Wahl der Drainage"],"prefix":"10.1055","volume":"146","author":[{"given":"Jarmil","family":"Safranek","sequence":"additional","affiliation":[{"name":"Chirurgische Klinik, Universit\u00e4tskrankenhaus Pilsen, Tschechische Republik"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Skala","sequence":"additional","affiliation":[{"name":"Chirurgische Klinik, Medizinische Fakult\u00e4t der Karlsuniversit\u00e4t und Universit\u00e4tskrankenhaus Pilsen, Tschechische Republik"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarka","family":"Vejvodova","sequence":"additional","affiliation":[{"name":"Chirurgische Klinik, Medizinische Fakult\u00e4t der Karlsuniversit\u00e4t und Universit\u00e4tskrankenhaus Pilsen, Tschechische Republik"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petr","family":"Hosek","sequence":"additional","affiliation":[{"name":"Biomedizinisches Zentrum, Medizinische Fakult\u00e4t der Karlsuniversit\u00e4t und Universit\u00e4tskrankenhaus Pilsen, Tschechische Republik"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,2,3]]},"reference":[{"key":"ref1","first-page":"545","article-title":"Descending necrotizing mediastinitis","volume":"157","author":"A S Estrera","year":"1983","journal-title":"Surg Gynecol Obstet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1007\/s00104-020-01121-x","article-title":"Schwere 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