新生儿舌甲状舌管囊肿的早期诊断10例报告

Early diagnosis of Hngual thyroglossal duct cyst in newborns： analysis of 10 cases previously misdiagnosed as laryngomalacia

目的使新生儿医生认识和重视新生儿舌甲状舌管囊肿（LTDC），从而避免将LTDC误诊为先天性单纯性喉喘鸣（即喉软化症）。方法总结2004年12月至2007年8月，我院新生儿科收治的10例LTDC患儿，本组10例在院外均误诊为先天性喉喘鸣。入院后5例进行了喉镜检查，10例全部进行了喉部CT扫描，7例进行组织病理学检查。结果10例均证实为LTDC。喉喘鸣为新生儿LTDC的首发症状，吸气性的呼吸困难是其主要表现；喉镜检查：可见舌根部圆形囊性肿物，色略灰白，表面光滑柔软；喉部CT扫描显示：舌根部圆形低密度灶，直径约0．8～2em，边界清楚，凸入气道；组织学检查：囊肿壁由鳞状上皮和柱状上皮组成。结论LTDC是新生儿甲状舌管囊肿的常见形式，喘鸣及呼吸困难是其主要表现；喉镜检查可作为新生儿LTDC的初筛手段，而喉部CT扫描则提供重要的诊断依据；囊肿穿刺虽可缓解症状，手术切除是LTDC的根治方法。

Objective To distinguish lingual thyroglossal duct cyst （LTDC） from laryngomalacia in newborn infants. Methods Data of 10 newborn infants with laryngeal stridor and dyspnea, admitted to the department of neonatology in our hospital during December, 2004 to August, 2007, who were finally diagnosed with LTDC though previously diagnosed as congenital laryngeal stridor in other hospitals, were summarized and analyzed. Results Inspiratory stridor with chest wall retractions was cardinal symptom of newborn with LTDC. A slightly gray and round cyst with smooth surface at the base of the tongue was found with laryngoscopy. On computed tomography examination of larynx, a well-circumscribed lesion with low intensity was detected at the base of the tongue protruding into the air passage. Pathological examination demonstrated that the cyst wall was composed of tabular and columnar epithelium. Conclusions LTDC is a common disease in newborns, which is similar to laryngomalacia. For neonates suspected of LTDC, laryngoscopic examination should be performed first, while laryngeal CT scan is an important diagnostic basis. Cyst puncture can ameliorate the symptoms of the patients, while surgical removal is the method of radical cure.