儿童梨状窝瘘41例

Pyriform sinus fistula in children with 41 cases

目的提高对儿童梨状窝瘘的认识,介绍相关诊断与治疗进展。方法报告41例梨状窝瘘病例,男16例,女25例,年龄9个月至12岁3个月;左侧40例,右侧1例;33例行颈部超声显像,20例行CT检查,29例行甲状腺核素显像,39例行食管吞钡造影。28例手术治疗,其中20例应用胃镜辅助,并对37例进行随访,随访时间18个月至17年6个月。结果超声检查显示:32例病变侧甲状腺实质不均质占位或软组织实质不均质占位,与甲状腺关系密切;CT检查提示:病变侧颈部炎性肿块或合并甲状腺内炎性占位性病变,其中5例直接诊断为梨状窝瘘;核素显像提示:26例甲状腺左叶、特别是上极放射性稀疏,2例呈"冷结节";食管吞钡检查显示:左侧或右侧梨状窝底部有垂直下行的细小瘘管。10例单纯切除术中8例治愈,2例复发,经胃镜辅助治愈;20例经胃镜辅助切除病例中,2例复发;13例未手术,其中9例获随访,5例自愈或未发作,4例仍反复发作。结论儿童梨状窝瘘炎症消退后食道吞钡检查可明确诊断,CT、B超及同位素检查在梨状窝瘘的诊断中也起着非常重要的作用,手术切除瘘管是主要的治疗方法,关键在于完整切除或消灭瘘管;胃镜辅助检查有助于瘘管的寻找,从而保证瘘管的完整切除,是一种简便、有效的治疗手段。

Objective To enhance the knowledge and show the advancements of diagnosis and treatment of pyriform sinus fstula. Methods 41 cases of pyriform sinus fistula were reported . There were 16 boys and 25 girls, aged from 9months to twelve years and 3 months. 40 in the left neck, 1 in the right. 33 had uhrasonography, 20 CT scan, 29 scintigraphy, 39 esphagogram, 28 did the operation of fistulectomy, within 20 underwent gastroscopic assitant fistulectomy. 37 cases were followed up for 18 month to 17 years and 6 months. Results Ultrasonograph in 32 cases showed inflammatory swelling in the region of the left/ right neck associated with the thyroid gland; CT scan showed abscess formation in the left/right side of the neck with involvement of left/right thyroid lobe; In 5 cases CT scan gave the direct diagnosis of pyriform sinus fistula; Scintigraph in 26 cases showed inflammation in the region of the left/right lobe of the thyroid gland, 2 cold nodules; Esphagogram showed the fistula; 10 patients did not use gastroscopic assitance,8 had no recurrence and 2 had recurrence during the period of follow-up, 20 with gastroscopic assitance（within 10 cases had fistulectomy in other or our hospital）, only 2 had recurrence; 9 got follow-up in 13 cases without operation, 5 got healing or in quiescency, 4 recrrence one more time. Conclusions Bariun swallow during the period of quiescency is essential for the diagnosis, in addition, CT scan , ultrasonography, and scintigraphy are also of importance. Complete removal of the fistula is the choice of treatment. Gastroscopic assistant operation is a simple, quick and effective operation for children with pyriforrn sinus fistula.