摘要
目的评价内镜CO2激光烧灼治疗儿童先天性梨状窝瘘（congenital pyriform sinus fistula，CPSF）的可行性及利弊。方法广东省人民医院耳鼻咽喉头颈外科2011年1月至2014年10月，采用CO2激光烧灼治疗19例窦道型儿童CPSF。其中，男8例，女11例；左16例，右3例；年龄15-144个月，平均58．3个月；14例初诊表现为下颈深部脓肿，5例为急性化脓性甲状腺炎；15例有上呼吸道感染史。术前检查包括下咽造影、颈部CT和MRI等。炎症感染期，行穿刺或切开引流，并根据药敏结果使用抗生素或经验性使用阿莫西林克拉维酸钾治疗。炎症静止期，实施内镜检查＋CO2激光梨状窝瘘内瘘口烧灼封闭术。术后3个月内镜复查，内瘘口未闭者，再行内镜烧灼。结果所有病例经内镜确认内瘘口。1次烧灼后梨状窝内瘘口闭合率为89．4%（17／19）；2次烧灼后累计闭合率为94．7％（18／19）；3次烧灼后累计闭合率为100％（19／19）。经历再次烧灼的2例患儿均为内镜复查发现内瘘口不完全闭合，但手术间隔期内无症状。所有患儿术后无声嘶、无呛咳、无吞咽困难、无牙齿脱落等并发症。随访6～55个月（平均24．2个月）未见复发。结论内镜CO2激光烧灼治疗CPSF安全、微创、美观、可重复性强，可作为儿童窦道型CPSF的首选治疗。
Objective To evaluate the feasibility, advantages and disadvantages of endoscopic carbon dioxide （CO2） laser cauterization （ECLC） for congenital pyriform sinus fistula （CPSF） in children. Methods A total of 19 children of endoscopically confirmed CPSF sinus type underwent ECLC between January 2011 to October 2014. There were 8 males and 1 l females with an average age of 58. 3 （15-144） months. The lesions were located at left （n = 16） and right （n = 3） sides. The presentations included deep neck abscess （n = 14） and acute suppurative thyroiditis （n = 5）. And 15 patients developed upper respiratory infection before an onset of initial symptoms. Preoperative examinations included barium swallow X-ray （BSX）, computed tomography （CT） and magnetic resonance imaging （MRI）. During acute infection phase, 13 patients underwent incision and drainage and antibiotics were used according to the results of antimicrobial susceptibility or amoxieillin plus clavulanic acid empirically. During quiescent period, the internal openings of CPSF were confirmed by suspension laryngoscopy and then ECLC on internal opening was routinely performed. Endoscopy was carried out 3 months later. And ECLC was indicated if internal opening was not complete closed. Results All patients were confirmed endoscopically. The closure rate of treatment after the first ECLC was 89. 4% （17/19）, the accumulative success rate after the second treatment 94. 7% （18/19） and the accumulative success rate after the third treatment 100% （19/19）. In 2 patients, incompletely closed orifices （without clinical symptoms） were identified and re-cauterized more than twice. Neither hoarseness nor cough occurred. There was no recurrence during an average follow-up period of 24. 2 （6-55） months. Conclusions Endoscopic CO2 laser cauterization is safe, mini-invasive, efficacious, cosmetic and repeatable so that it may become a first-line treatment for sinus type of CPSF in children.
出处
《中华小儿外科杂志》
CSCD
2015年第12期890-893,924,共5页
Chinese Journal of Pediatric Surgery
基金
“十二五”国家科技支撑计划“中国罕见疾病防治研究与示范”项目（21113BA107800）
关键词
瘘
自然腔道内镜手术
激光疗法
Fistula
Natural orifice endoscopic surgery
Laser therapy
