内镜辅助治疗儿童梨状窝瘘13年随访：单中心147例报道

Endoscope-assisted surgery for pyriform sinus fistula in children over 13 years： a review of 147 cases at a single institution

自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1d～13．8岁，平均3．7岁；发病后6d～14．8年明确诊断，平均32．0个月；手术年龄为17d～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。

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 endoscopicalty. With a callback after a week, they were followed up for 3 - 157. 2 months. 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.