婴幼儿舌根囊肿的诊断及围手术期治疗要点

Diagnosis and perioperative treatment of tongue base cyst in infants

目的：探讨婴幼儿舌根囊肿诊断、手术及围手术期治疗的要点。方法回顾性分析因舌根囊肿而进行手术治疗的38例婴幼儿患者病历资料，诊断主要依靠患儿病史、体格检查、辅助检查三方面，全麻下行低温等离子射频消融术，术后对症治疗。结果38例患儿舌根囊肿全部切除。其中3例因呼吸困难，术前即于儿童重症监护病房（ICU）行气管插管，术后带管转入 ICU 病房后顺利拔管出院；5例因合并严重喉软骨软化或其他疾病，术后带管转入 ICU 病房后顺利拔管出院；余30例术后拔管返回耳鼻喉病房。38例中2例出现麻醉插管困难，紧急予囊肿穿刺减张后顺利插管。全部患儿术后行电子喉镜复查，随诊8个月～2年无复发。结论电子喉镜及颈部 B 超检查可准确诊断舌根囊肿，低温等离子射频消融术治疗舌根囊肿具有损伤小、出血少等显著优点。舌根囊肿的婴幼儿患者麻醉风险较高，必要时需先行囊肿穿刺减张后实行麻醉；新生儿且合并其他疾病的患儿为避免术后呼吸困难可带管转入 ICU 病房。舌根囊肿术后需严密监测生命体征，避免术后呼吸困难的发生。

Objective To discuss the diagnosis,surgery and perioperative treatment of tongue base cyst in infants. Methods Clinical data of 38 patients with tongue base cyst were reviewed.Diagnoses were confirmed by the medical history,physical examination and auxiliary examinations.Radiofrequency ablation was used to treat all the patients un-der general anesthesia.Symptomatic treatments were given post-operatively.Results The cysts were removed in all the 38 patients.Due to severe apnea,3 patients were intubated preoperatively and sent back to intensive care unit （ICU）after the operation.They were extubated 2 or 3 days later and discharged.Another 5 patients were transferred to ICU with intubation after the operation because of other illness and extubated there.The rest 30 patients were extubated soon after the operation and sent back to ENT department.During the surgery,the cysts in 2 patients were punctured to decrease the size to ease the intubation.All the patients underwent electronic laryngoscopy postoperatively.No relapse was noted in 8 months to 2 years follow-up.Conclusion Electronic laryngoscopy and neck B ultrasound examination can accurately diagnose the tongue base cyst.There are significant advantages for radiofrequency ablation to treat tongue base cyst,such as less injury and less bleeding.The infants with tongue base cyst always have high risk for anesthesia and intubation.If necessary,puncture to relieve the tension of the cyst can be performed before the operation.Patients combined with other disease or neonatal patients can be transferred to ICU for further treatment.After the surgrey,all the patients should be monitored closely in case of apnea or other airway emergency.