儿童异位型支气管源性囊肿21例临床分析

Clinical analysis of 21 cases of children with ectopic bronchogenic cyst

目的分析儿童异位型支气管源性囊肿的临床特征、治疗及预后情况。方法该病例系列研究回顾性分析了郑州大学附属儿童医院自2015年7月至2023年12月收治的经病理确诊的21例异位型支气管源性囊肿患儿的临床资料,其中男性16例,女性5例,男女比例为3.2∶1;年龄为出生4 d至8岁(中位年龄2岁8个月),并对其临床特点、辅助检查、治疗情况进行分析。结果21例异位支气管源性囊肿中,发生在咽部11例,其中有呼吸困难的4例,睡眠打鼾3例,呛奶4例;头颈部、前胸部10例中,有感染史5例,包块间渐进长大的5例。影像学及内镜检查:9例患儿行术前彩超检查,报告肿物为囊性包块,边界清晰。13例行CT检查,表现为类圆形或圆形,密度均匀、边缘光滑、囊壁规整,CT值为2~52 HU不等。4例行MRI检查,均为囊性病变,其中3例为长T1长T2信号,1例为稍短T1长T2信号影,压脂呈高信号。咽部11例行电子鼻咽喉镜检查,肿物呈球形或椭圆形,表面光滑,颜色为接近或略浅于周围组织色泽,其中1例口咽部为蓝色。11例发生在咽部患儿均在全身麻醉插管状态下,行低温等离子肿物切除术。术中采用鼻内镜辅助,牵拉肿物,尽可能切除肿物。10例发生在颈部、前胸部患儿肿物完整切除。术后病理均回报为:支气管源性囊肿。21例患儿术后,1例失访,余分别随访4个月至7年,均无复发。结论本病临床比较罕见,患儿缺乏典型的影像学特征及临床表现,对于发生于颈部及前胸部位的患儿,结合超声、CT、MRI检查结果,而咽部位需结合电子鼻咽喉镜检查结果,手术治疗为该病的首选治疗方式。

Objective:To analyze the clinical characteristics,treatment,and prognosis of ectopic bronchogenic cysts in children.Methods:A retrospective analysis was conducted on the data including the clinical characteristics,auxiliary examination and treatment of 21 children with ectopic bronchogenic cysts diagnosed pathologically at Children′s Hospital Affiliated to Zhengzhou University from July 2015 to December 2023.There were 16 males and 5 females,with a male-female ratio of 3.2∶1,and the age ranged from 4 days to 8 years old(median age 2 years and 8 months).Results:Among the 21 cases of ectopic bronchogenic cysts,11 cases were found in the pharynx,with symptoms including dyspnea(4 cases),snoring during sleep(3 cases),and choking on milk(4 cases).Ten cases were found in the head,neck or anterior chest,5 of these cases had infection history,and 5 showed progressive mass growth.Imaging and endoscopy showed 9 patients underwent preoperative color ultrasonography revealed cystic masses with well-defined boundaries.CT examination was performed on 13 patients,which showed round or nearly round masses with homogeneous density,smooth margins,and regular cyst walls.CT attenuation values ranged from 2 to 52 Hounsfield Units(HU).Four cystic lesions were assessed via MRI,3 cases demonstrated long T1 and long T2 signals,while 1 case had a slight short T1 and long T2 signal,with high signal intensity on fat-suppressed images.Eleven cases of pharyngopharyngeal cysts were examined by electronic nasopharyngoscopy.The cysts appeared as spherical or ovoid masses with smooth surfaces,close to or slightly light in color with the surrounding tissue,with one cyst presenting with a bluish blue in the oropharynx.All 11 pharyngeal cysts were excised using low-temperature plasma under general anesthesia and intubation assisted by a nasal endoscope.The cysts were pulled and excised as completely as possible.Ten cases of neck and anterior chest cysts were completely excised.Postoperative histopathology confirmed bronchogenic cyst.Twenty-one children were followed up postoperatively for 4 months to 7 years without recurrence,except for 1 patient who was lost to follow-up.Conclusions:Ectopic bronchogenic cysts are uncommon and lack of typical imaging and clinical features.Combination of ultrasonography,CT and MRI is recommended for cases occuered in neck and anterior chest,while electronic nasopharyngoscopy complements pharyngeal evaluations.Surgical intervention is the preferred treatment choice for this disease.