基于瘘管分段解剖的改良梨状窝瘘管切除术临床应用

Clinical application of modified fistulectomy in the treatment of congenital pyriform sinus fistula based on segmental anatomy of fistula

目的:探讨基于瘘管分段解剖的改良梨状窝瘘管切除术的临床应用及意义。方法:回顾分析84例采用改良梨状窝瘘管切除术治疗的先天性梨状窝瘘(CPSF)患者临床资料。该术式采用瘘管顺行解剖法对瘘管进行精确定位、精细解剖,术程可归纳为4步,即喉返神经逆行解剖、喉上神经外支解剖、瘘管顺行解剖和甲状腺部分切除。结果:所有患者均顺利接受手术,手术时间(64.6±20.0) min,术中出血(19.6±13.0) mL,平均住院时间(6.8±1.1) d。术后感染1例(1.19%),暂时性声带麻痹1例(1.19%),无出血、咽瘘、吞咽困难、呛咳、永久性声带麻痹及甲状腺功能低下等,并发症发生率为2.3%(2/84)。随访57~106个月(中位74个月),无复发。结论:基于瘘管分段解剖的改良术式,不仅将传统术式化繁为简,更将具体步骤程序化,有的放矢、精准切除,为彻底消灭病灶、显著减少并发症及复发提供了行之有效的手术方案。

Objective:To discuss the clinical application and significance of the modified piriform fossa fistulectomy based on segmental anatomy of fistula.Methods:The clinical data of 84 patients with CPSF treated by modified pyriform sinus fistulectomy were analyzed retrospectively.The modified piriform fossa fistula resection adopts the fistula anterograde anatomy method to fine dissect the fistula.The operation procedure can be summarized into four parts:retrograde anatomy of recurrent laryngeal nerve,anatomy of external branch of superior laryngeal nerve,anterograde anatomy of fistula and partial thyroidectomy.Results:All 84 patients successfully completed the operation and discharged from the hospital.The operation time was(64.6±20.0) min,the intraoperative bleeding was(19.6±13.0) mL,and the average hospital stay was(6.8±1.1) d.Postoperative infection occurred in 1 case(1.19%),temporary vocal cord paralysis in 1 case(1.19%),no bleeding,pharyngeal fistula,dysphagia,permanent vocal cord paralysis and choking cough.The incidence of complications was 2.3%(2/84).No complications such as permanent vocal cord paralysis and hypothyroidism occurred.Follow up for 57-106(Median 74) months showed no recurrence.Conclusion:A modified procedure based on segmental dissection of the fistula not only simplifies the traditional procedure,but also procedures the specific steps to provide a targeted and precise resection,which provides a proven surgical solution for complete eradication of the lesion and significantly reduces complications and recurrence.