CAJ | 학술논문

目的探讨内镜辅助治疗儿童先天性梨状窝瘘(congenital pyriform sinus fistula,PSF)的经验及疗效.方法回顾性分析1999年7月至2012年12月内镜辅助治疗147例PSF患儿(男90例,女57例)的临床资料.本组临床表现为颈部反复感染、颈部肿块和呼吸受限等.17例在新生儿期或幼儿期表现为颈部囊肿.本组发病年龄在生后1 d～13.8岁,平均3.7岁;发病后6 d～14.8年明确诊断,平均32.0个月;手术年龄为17 d～15岁,平均5.5岁.术前行食管吞钡造影、颈部超声显像、颈部CT、同位素核素显像等检查.炎症控制期胃镜辅助治疗.结果瘘位于左侧138例,右侧7例,双侧2例.术中成功使用胃镜辅助找到瘘管143例(97.3％).术中发现瘘管自甲状软骨下角后方穿出34例,下角前14例,下角下12例.术中发生食道损伤2例,1例术后声音嘶哑.术后随访时间3～157.2月,5例(3.4％)复发,其中2例再次手术切除瘘管,另3例随访6.3～97.7月无临床症状.余142例术后恢复良好.结论 PSF并不如想象中少见,在治疗儿童颈部感染性疾病或肿块,特别是左侧病变时,应提高警惕.内镜辅助有助于寻找定位瘘管,从而使PSF切除更容易、精确,减少手术创伤.
목적 탐토내경보조치료인동선천성리상와루(congenital pyriform sinus fistula,PSF)적경험급료효.방법 회고성분석1999년7월지2012년12월내경보조치료147례PSF환인(남90례,녀57례)적림상자료.본조림상표현위경부반복감염、경부종괴화호흡수한등.17례재신생인기혹유인기표현위경부낭종.본조발병년령재생후1 d～13.8세,평균3.7세;발병후6 d～14.8년명학진단,평균32.0개월;수술년령위17 d～15세,평균5.5세.술전행식관탄패조영、경부초성현상、경부CT、동위소핵소현상등검사.염증공제기위경보조치료.결과 루위우좌측138례,우측7례,쌍측2례.술중성공사용위경보조조도루관143례(97.3％).술중발현루관자갑상연골하각후방천출34례,하각전14례,하각하12례.술중발생식도손상2례,1례술후성음시아.술후수방시간3～157.2월,5례(3.4％)복발,기중2례재차수술절제루관,령3례수방6.3～97.7월무림상증상.여142례술후회복량호.결론 PSF병불여상상중소견,재치료인동경부감염성질병혹종괴,특별시좌측병변시,응제고경척.내경보조유조우심조정위루관,종이사PSF절제경용역、정학,감소수술창상.
Objective Congenital pyriform sinus fistula (PSF) is relatively rare,but it often presents diagnostic and therapeutic challenges.Here we reported our experience of endoscope-assisted surgery for pediatric PSF.Methods Since 1999,a total of 147 children (90 males,57 females) with PSF had been enrolled.Their clinical manifestations included recurrent lateral neck infection,neck mass and respiratory distress.Preoperative examinations included barium enema,ultrasound,computed tomography and thyroid scan.After treatment and resolution of infection; fistula was demonstrated endoscopically.With a callback after a week,they were followed up for 3-157.2months.Results The age-of-onset ranged from the first day of life to 13.83 years (mean,3.7 years).It took 6 days to 178 months (mean,32.0 months) to diagnose from the age-of-onset.The average operative age was 5.5 years (17 days to 15 years).And 138 openings of PSF were located at left side,7 right and 2 bilateral.And 17 of them presented a large cervical cyst.Gastroscopy was successfully conducted in 143 cases (97.3％).The fistula traversed posterioinferior cornu of thyroid cartilage (n =34),anterior (n =14) and inferior (n =12).Esophageal injury occurred in 2 cases.One patient developed postoperative hoarseness.Recurrent PSF was found in 5 cases.Two of them were cured by re-excision.Another 3 remained asymptomatic for 6.3 to 97.7 months.The remainder recovered well during the follow-up.Conclusions PSF is not as rare as expected.And a higher index of suspicion for PSF should be raised in the management of neck lesions in children.With the aid of endoscope,PSF excision may be easier,more precise and less traumatic.