中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2011年
9期
728-732
,共5页
瘘%下咽%鳃区%先天畸形%脓肿
瘺%下嚥%鰓區%先天畸形%膿腫
루%하인%새구%선천기형%농종
Fistula%Hypapharynx%Branchial region%Congenital abnormalities%Abscess
目的 探讨先天性梨状窝瘘管(congenital pyriform sinus fistula，CPSF)的临床表现和治疗原则。方法 对2007年1月至2011年1月经手术确认连接梨状窝与甲状腺叶瘘管的7例CPSF患者资料进行分析。患者均表现为复发性左侧颈部低位脓肿或急性化脓性甲状腺炎，所有患者均有误诊病史，病程3 ～11年，均曾数次行切开引流或外科探查。急性感染期患者脓肿切开引流，炎性反应消退后进行检查和根治性手术。结果 炎性反应静止期CT检查，均可见左侧甲状腺叶深面及其周围间隙瘢痕组织增生；6例患者行X线钡餐检查，5例可见源于梨状窝的瘘管。4例患者术前行直达喉镜检查，3例可见位于梨状窝尖部附近的瘘口。手术切除瘘管及左侧部分甲状腺叶，保护喉返神经。术后恢复顺利，未出现永久性喉返神经麻痹或甲状腺功能低下等并发症。随访5～40个月，未见复发。结论 对于有反复发作下颈部脓肿病史的患者，尤其位于左侧者，应高度怀疑CPSF的存在，X线钡餐和CT检查是有效的诊断方法，完整切除瘘管及受累甲状腺叶可治愈CPSF。
目的 探討先天性梨狀窩瘺管(congenital pyriform sinus fistula，CPSF)的臨床錶現和治療原則。方法 對2007年1月至2011年1月經手術確認連接梨狀窩與甲狀腺葉瘺管的7例CPSF患者資料進行分析。患者均錶現為複髮性左側頸部低位膿腫或急性化膿性甲狀腺炎，所有患者均有誤診病史，病程3 ～11年，均曾數次行切開引流或外科探查。急性感染期患者膿腫切開引流，炎性反應消退後進行檢查和根治性手術。結果 炎性反應靜止期CT檢查，均可見左側甲狀腺葉深麵及其週圍間隙瘢痕組織增生；6例患者行X線鋇餐檢查，5例可見源于梨狀窩的瘺管。4例患者術前行直達喉鏡檢查，3例可見位于梨狀窩尖部附近的瘺口。手術切除瘺管及左側部分甲狀腺葉，保護喉返神經。術後恢複順利，未齣現永久性喉返神經痳痺或甲狀腺功能低下等併髮癥。隨訪5～40箇月，未見複髮。結論 對于有反複髮作下頸部膿腫病史的患者，尤其位于左側者，應高度懷疑CPSF的存在，X線鋇餐和CT檢查是有效的診斷方法，完整切除瘺管及受纍甲狀腺葉可治愈CPSF。
목적 탐토선천성리상와루관(congenital pyriform sinus fistula，CPSF)적림상표현화치료원칙。방법 대2007년1월지2011년1월경수술학인련접리상와여갑상선협루관적7례CPSF환자자료진행분석。환자균표현위복발성좌측경부저위농종혹급성화농성갑상선염，소유환자균유오진병사，병정3 ～11년，균증수차행절개인류혹외과탐사。급성감염기환자농종절개인류，염성반응소퇴후진행검사화근치성수술。결과 염성반응정지기CT검사，균가견좌측갑상선협심면급기주위간극반흔조직증생；6례환자행X선패찬검사，5례가견원우리상와적루관。4례환자술전행직체후경검사，3례가견위우리상와첨부부근적루구。수술절제루관급좌측부분갑상선협，보호후반신경。술후회복순리，미출현영구성후반신경마비혹갑상선공능저하등병발증。수방5～40개월，미견복발。결론 대우유반복발작하경부농종병사적환자，우기위우좌측자，응고도부의CPSF적존재，X선패찬화CT검사시유효적진단방법，완정절제루관급수루갑상선협가치유CPSF。
Objective To explore the clinical presentation and management principles of congenital pyriform sinus fistula. Methods Seven sequential cases of congenital pyriform sinus fistula (CPSF) treated between January 2007 and January 2011 were reported. The clinical presentation were recurrent left lower neck abscess or acute suppurative thyroiditis. All of these patients had past histories of misdiagnosis ranged from 3 years to 11 years. All the patients had undergone incision and drainage several times. In acute infection period, these patients received incision and drainage, after inflammation susided, were treated with definitive surgery. Results After barium swallow study and CT examination in the quiescent stage of infection, 5 patients could be seen fistula in the pyriform, all the patients were found scar tissue near the left thyroid lobe, 4 patients received direct laryngoscope examination and 3 of them could be found inner orifice near the apex of pyriform sinus, fistula and the involved lobe of thyroid were successfully excised without permanent recurrent laryngeal nerve injury or hypothroidism. All the patients had an uneventful recovery and remained symptom free from 5 months to 40 months. Conclusions The clinical history of recurrent low neck inflammatory episodes in patients, especially on the left side, should raise the suspicion of CPSF,investigation using barium swallow in combination with CT scanning is useful. CPSF can be treated by excising the fistula and involved lobe of thyroid.
