儿童非囊肿型先天性梨状窝瘘的诊断及内镜微创治疗效果

Effect of diagnosis and endoscopic minimally invasive treatment of non-cystic congenital pyriform sinus fistula in children

摘要:

目的 探讨儿童非囊肿型先天性梨状窝瘘（CPSF）的诊断和内镜下微创手术治疗效果。方法 回顾性分析2017年10月－2022年5月该院收治的76例非囊肿型CPSF患儿的临床资料，行喉镜、颈部彩超、食道钡餐、颈部CT和磁共振成像（MRI）检查，于全身麻醉支撑喉镜引导下，行低温等离子射频消融术。结果 喉镜下可见梨状窝处内瘘口，影像学检查可见瘘管与咽部相通；术后发生暂时性声者嘶哑3例，乳牙脱落3例；术后随访12～40个月，46例初治患儿复发1例，30例非初治患儿复发1例，再次行内镜下低温等离子烧灼，术后随访均无复发。结论 CPSF症状无特异性，内镜下发现内瘘口是诊断的金标准，超声可作为初筛手段，食道钡餐联合CT检查可提高诊断率，MRI可作为辅助诊断；支撑喉镜下低温等离子射频消融术具有安全、微创、美观、便捷和可重复操作等优点，可作为儿童非囊肿型CPSF治疗的首选方法。

Abstract:

Objective To explore the effect of the diagnosis and endoscopic minimally invasive surgical treatment of non-cystic congenital pyriform sinus fistula (CPSF) in children.Methods Clinical data of 76 children with non-cystic CPSF were retrospectively analyzed from October 2017 to May 2022. Larygoscope, neck color ultrasound, esophageal barium meal, neck CT, and magnetic resonance imaging (MRI) were performed, and temperature-controlled ablation radio-frequency was performed under general anesthesia supported by laryngoscope guidance.Results The internal fistula in the pyriform fossa was seen under laryngoscope. Imaging examination shows that the fistula was connected to the pharynx. Postoperative complications: hoarseness in 3 cases and deciduous tooth loss in 3 cases. After a follow-up period of 12 ~ 40 months, there was 1 recurrence in 46 newly treated patients and 1 recurrence in 30 non newly treated patients. No recurrence was observed during the follow-up period after re-endoscopic radiofrequency plasma surgical electrodes plasma cauterization.Conclusion The symptoms of CPSF are non-specific. The discovery of the internal fistula under endoscopy is the gold standard for diagnosis. Ultrasound can be used as the initial screening method for diagnosis. Esophageal barium meal combined with CT examination can improve the diagnostic rate, and MRI can assist in diagnosis. The temperature-controlled ablation radio-frequency technique under supportive laryngoscope has the advantages of safety, minimally invasive, aesthetic, convenient, and repeatable operation, and can be used as the preferred method for the treatment of non-cystic CPSF in children.