超声对新生儿与儿童先天性梨状窝瘘的诊断价值

Comparison of Sonographic Findings Between Newborns and Children with Congenital Pyriform Sinus Fistula

目的探讨新生儿与儿童期先天性梨状窝瘘(CPSF)的超声表现,为制订合理的临床决策提供客观依据。资料与方法回顾性分析2014年1月—2021年6月于广州市妇女儿童医疗中心收治并经手术病理证实的49例CPSF患儿的术前超声资料,其中新生儿23例,儿童26例。比较两组患儿超声图像特点,包括颈部肿块情况、周围组织回声改变、毗邻结构以及甲状腺变化(紧邻关系、形态变化、回声改变)等。结果两组肿块回声、气管移位差异均有统计学意义(χ^(2)=24.464、4.146,P均<0.05);两组超声特点中,紧邻甲状腺、甲状腺形态变化、甲状腺回声改变、甲状腺形态回声变化比较,差异有统计学意义(χ^(2)=4.446、6.355、11.314、4.091,P均<0.05)。新生儿组以囊性为主(65.2%,15/23);儿童组以低回声为主(53.8%,14/26)。新生儿组CPSF可以观察到明显气管移位(21.7%,5/23);儿童组CPSF颈部肿物不仅紧邻甲状腺(76.9%,20/26),而且侵犯到一定程度可致腺体发生显著的形态变化(30.8%,8/26)、回声变化(53.8%,14/26),或形态与回声同时发生改变(23.1%,6/26)。新生儿组与儿童组CPSF的超声诊断准确度分别为52.2%(12/23)和76.9%(20/26)。结论新生儿CPSF超声表现以囊性肿物多见,气管移位较明显;儿童期则以低回声实性肿块常见,常累及甲状腺。

Purpose To evaluate the sonographic findings for differentiating between newborns and children with congenital pyriform sinus fistula(CPSF),and to provide objective evidence for making reasonable clinical decisions.Materials and Methods The preoperative ultrasound data of 49 patients with CPSF who were admitted to Guangzhou Women and Children Medical Center from January 2014 to June 2021 and confirmed by surgery and pathology were retrospectively analyzed,including 23 neonates and 26 children.The ultrasound imaging features between the two groups were compared,including neck mass,echo change of surrounding tissue,adjacent structure and thyroid gland changes(relationship,morphological change,echo change).Results There were significant differences in mass echo and tracheal displacement between the two groups(χ^(2)=24.464,4.146,P<0.05).There were significant differences in thyroid morphology,thyroid echo,thyroid morphology and thyroid echo between the two groups(χ^(2)=4.446,6.355,11.314,4.091,P<0.05).Cystic disease was predominant in neonatal group,accounting for 65.2%(15/23).The children group was mainly hypoechoic,accounting for 53.8%(14/26).Significant tracheal displacement was observed in neonatal CPSF(21.7%,5/23).Neck masses of CPSF in children were not only closely related to thyroid gland(76.9%,20/26),but also caused significant morphological changes(30.8%,8/26),echo changes(53.8%,14/26),or simultaneous morphological and echo changes(23.1%,6/26).The accuracy of ultrasonic diagnosis of CPSF in neonates and children was 52.2%(12/23)and 76.9%(20/26),respectively.Conclusion The ultrasonic manifestations of neonatal CPSF were cystic mass with obvious tracheal displacement,while childhood are common with hypoechoic solid masses,often involving the thyroid gland.