23例2个月内小儿舌甲状舌管囊肿的临床特征

Clinical characteristics of 23 cases in two months old of neonatal lingual thyroglossal duct cysts

目的 通过分析2个月内小儿舌甲状舌管囊肿（lingual thyroglossal duct cysts,LTGDC）的临床特点,提高诊治水平.方法 对23例2个月内的小儿LTGDC与对照组20例1～7岁小儿颈部甲状舌管囊肿（thyroglossal duct cysts,TGDC）的临床资料进行对比分析.结果 23例2个月内小儿LTGDC的临床表现与对照组TGDC患儿明显不同,LTGDC以喉喘鸣为主要表现,有74％以呼吸困难急诊就诊,易误诊为先天性喉软化症或喉软化症合并肺炎;病变位于舌骨后上舌根后方,因突向喉咽腔易导致喉阻塞;电子喉镜检查为首选,有助于鉴别喉软化症、会厌囊肿等;喉部CT/MRI检查为边界清楚的类圆形低密度影,对于确诊未完全突出至喉咽腔的、喉镜下容易漏诊的LTGDC非常重要;治疗采用经口支撑喉镜下手术,手术微创,颈部无瘢痕.20例TGDC均以颈前中线包块为首发症状;颈部超声检查为首选,病变在超声下为边界清楚的液性暗区;手术需采取颈部经皮切开手术.结论 2个月内小儿LTGDC临床表现不同于TGDC,是喉喘鸣伴呼吸困难的常见原因,容易误诊为先天性喉软化症,救治不及时易窒息死亡,应该引起足够的重视.

Objective To analyse the clinical characteristics of infants in two months old of lingual thyroglossal duct cysts （LTGDC） and raise the levels of diagnosis and treatment. Methods A comparative analysis was made between the clinical data of 23 cases in two months old of LTGDC and those of 20 cases in one to seven years old of cervical thyroglossal duct cysts （TGDC） （ control group）. Results The clinical manifestation appeared obviously differences between LTGDC and TGDC. The main performance of LTGDC was laryngeal stridor, and 74% of them went to emergency department because of dyspnea. They would be misdiagnosed as congenital laryngomalacia or laryngomalacia with pneumonia. The lesion located in the pos- terosuperior of lingual bone and behind the root of tongue, which was easy to lead to throat obstruction be- cause it extruded laryngeal cavity. Electronic laryngoscopy was the first choice, it helped to identify laryngo- malacia,epiglottis cyst and hemangioma. Laryngeal CT or MRI was very important to diagnose LTGDC which was quasi-circular low density shadow with clear boundary, or not extruded to laryngeal cavity, or show lesion range and surrounding structures avoiding misdiagnosis. As treatment depended surgery which was self- retaining laryngoscope, it was minimally invasive and without scar. Cervical anterior mass in the midline was the first symptoms in all 20 cases of TGDC. The neck ultrasound examination was the first selection, and the lesion showed fluid dark space with clear boundary,it should take the neck percutaneous surgical operation. Conclusion The clinical manifestation of infants in two months old of LTGDC appears obviously different from TGDC. LTGDC is a common cause of laryngeal stridor with breathing difficulties. It will be misdiag- nosed as congenital laryngomalacia and lead to asphyxia or death easily.