胃镜辅助下电凝钩内口烧灼术治疗梨状窝瘘

Efficacy of treating pyriform sinus fistula with gastroscope-assisted unipolar electrocoagulation

目的探讨胃镜辅助下电凝钩烧灼梨状窝内口治疗先天性梨状窝瘘的经验及疗效。方法收集2016年3月至2017年2月间在复旦大学附属儿科医院外科接受胃镜辅助下电凝钩内口烧灼术治疗的梨状窝瘘患儿的临床资料,包括术前感染情况、禁食时间、手术时长、术后管理及复发情况。结果期间共有24例梨状窝瘘患儿接受胃镜辅助下电凝钩内口烧灼术治疗。其中,男13例,女11例。左侧梨状窝瘘22例,右侧2例。平均年龄为6.04岁(0.46~16岁),21例曾有局部感染史,其中13例曾行切开引流术,3例有手术史。所有患儿术前均行食管吞钡检查。所有病例术前禁食时间均为常规的8h。手术平均时间为30.7min(7~60min),平均住院时长6.83d(3~15d)。术后随访2~10个月,共有7例复发(复发率29.2%);17例无复发(治愈率70.8%)。所有病例术后均无牙齿脱落、声音嘶哑及呛咳等并发症。结论胃镜辅助下电凝钩烧灼梨状窝内口治疗先天性梨状窝瘘并发症少、手术时间及住院时间短、可重复性强,复发率与传统梨状窝瘘切除术相当,可作为治疗儿童先天性梨状窝瘘的首选治疗方式。术中注意需沿内口环形一周烧灼,避免遗漏黏膜,需有一定深度,至少1mm。

Objective To explore the efficacy of treating pyriform sinus fistula with gastroscope-assisted unipolar electrocoagulation. MethodsA retrospective analysis was performed for 24 hospitalized children of pyriform sinus fistula from March 2016 to February 2017.Gender, age, operative duration and recurrence were analyzed. ResultsAll of them underwent gastroscope-assisted unipolar electrocoagulation.Among them, there were 13 boys and 11 girls with an average age of 6.04 (0.46-16) years.The involved side was right (n=2) and left (n=22). Twenty-one had a previous history of local infection, 13 received incision plus drainage and 3 were operated.All preoperative diagnose were made through barium meal examination.The preoperative fasting time was 8h, the average operative duration 30.7 (7-60) min, the average hospital stay 6.83(3-15) days and the postoperative follow-up period 2 to 10 months.Seven cases relapsed with a recurrence rate of 29.2% while the remainders were cured with a curative rate of 70.8%.None of them had such postoperative complications as tooth loss, hoarseness or choking. ConclusionsGastroscope-assisted unipolar electrocoagulation is both minimally invasive and repeatable with few complications.It may be used as the first choice for pyriform sinus fistula.During operation, it is necessary to burn a full circle of fistula for avoid missing mucous membrane.Also a certain depth of at least 1mm is required.