口腔底蜂窩性組織炎（Ludwig's Angina）之預後因素及其治療

The Prognostic Factors and Treatment of Ludwig's Angina

本研究以病歷回溯方式收集1998年1月至2003年6月，在台大醫院診斷為Ludwig's angina（口腔底蜂窩性組織炎）的病例，分析其性別、年齡、罹病月份、病因、症狀、有無清創引流、深頸部擴散（deep neck infection）、氣切手術等因素來找出影響Ludwig's angina病情復原的因素及提出最佳的治療的方法。結果在44例中，男性29例、女性15例，男女比例約為2：1，平均年齡48.1歲。最常見的病因以齒源性感染最多，有36例，佔81.8﹪。44例中並無死亡的案例，在平均氣溫較低的月份（11-4月）Ludwig's angina較多發生，有膿瘍擴散至頸部者常需接受清創引流術，而有做清創引流術者及有氣切或插管者，其平均住院日數較長，康復所需時間較久，而年齡較大者（>50歲）及有全身性系統性疾病者如高血壓、糖尿病等，在臨床上雖有較長的住院日數，但在統計學上並無意義。

With retrospective chart review, 44 patients diagnosed as Ludwig's angina at the National Taiwan University Hospital were collected from 1998 to 2003. The age ranged from 4 to 85 years (mean, 48.1 years), there were 29 male and 15 female. Ludwig's angina usually occurred in cold weather (November to April) and the most frequent etiology was dental infection (81.8%) followed by upper airway infection (11.3%). There were 5 cases that received tracheostomy or intubation, but no case expired in this study. The patients who had associated deep neck infection usually received drainage operation, and those who received incision drainage or tracheostomy usually had a longer hospital stay (P<0.05). Though older patients (>50 years old) and those with systemic diseases had longer hospital stays but the difference was not significant. The most important way to manage Ludwig's angina is to keep the airway patent, and the abscess must be drained out to prevent the fatal evidence. The antibiotics of penecillin, clindamycin or chloramphenicol should be used first before the available results of pus culture.