摘要
目的:分析儿童第四鳃裂畸形的临床特征和颈部开放手术的特征,明确其正确的诊断方法,探讨完整切除病变组织及减少术后并发症的手术技巧。方法:对6例存在梨状窝内窦口的第四鳃裂畸形患儿的流行病学、临床病征、放射影像学、外科手术特征进行回顾性分析,并结合文献对第四鳃裂畸形的正确外科处置方法进行探讨;全部患儿均在导管双向示踪辅助下行颈部开放手术彻底切除瘘管及病变组织,单极电凝补充处理内窦口;系统内镜随访。结果:6例患儿平均随访14个月(1～3年),均无临床症状复发;2例患儿分别在术后第3、4个月内镜随访时发现梨状窝内窦口复发(亚临床症状患儿);6例患儿术后均无声音嘶哑、低沉及饮水呛咳出现。结论:对于儿童反复发作的急性化脓性甲状腺炎和位于颈前区中下部的颈深部脓肿(尤其是病变位于左颈部者)应行CT增强扫描检查和直接喉镜检查以明确有无第四鳃裂畸形病变的存在;直接喉镜检查发现梨状窝尖部内窦口和毗邻Betz黏膜皱襞的存在,术中探查发现瘘管组织穿越环甲膜区域走行于喉上神经以下可确诊为第四鳃裂畸形;颈部开放手术彻底切除瘘管及病变组织是治疗儿童第四鳃裂畸形的有效方法;导管双向示踪有助于术中识别瘘管组织和确定内窦口位置;甲状软骨翼板后下方部分骨质的切除有助于喉返神经的充分显露和保护;甲状腺上极部分腺体的联合切除有助于病变组织的完整切除;单极电凝补充烧灼内窦口黏膜有助于彻底封闭内窦口。
Objective：To clarify the correct diagnostic methods of FBPS of children,and to explore technigues and technology of surgical operation aim to complete excision of sinus tract and preservation of the recurrent laryngeal nerve through analyzing the clinical characteristics and the characteristics of open neck surgery in FBPS of children.Method：Clinical materials of 6 children FBPS with internal pyriform sinus were retrospectively analyzed,and literatures were studied to explor the appropriate surgical management of children FBPS;lesions of 6 patients were completely dissected by open neck surgery with the help of di-direction catheterization revealing the tract of fistula,and the openings of the fistula to pyriform apex were cauterized by monopolar coagulation at the end of the procedure;all 6 cases were with systematic endoscopic follow-up.Result：All cases of 6 children patients were cured by open neck surgery,no recurrencs of clinical symptoms were observed during a mean follow-up of 14 months（1-3 years）;2 cases were diagnosed with an ＂anatomical＂ relapse（persistence of the sinus tract orifice without clinical symptoms） at the follow-up endoscopy（at 3 and 4 months after surgery）;all 6 cases had no complication of laryngeal paralysis.Conclusion：The children patients presenting recurrent acute suppurative thyroiditis and deep neck abscess of anterior area in the lower part of neck,especially locating left neck,should be considered as the diagnosis of FBPS,also the same as confirmed by enhanced neck CT scan and direct laryngoscopy.Patients with identification of internal pyriform sinus and Betz fold by direct laryngoscopy,and with identification of fistula which passes through the cricothyroid membrane beneath the superior laryngeal nerve can be confirmed FBPS.Completely dissection of sinus tract by open neck surgery was the effective management of children FBPS and di-direction catheterization aids to reveal and identify the tract of fistula.Resection of the posterior part of the thyroid cartilage ala can be useful to aid exposure and preservation of the recurrent laryngeal nerve;but co-excision of a portion of the upper of the thyroid gland aids to the entire dissection of lesions.In addition,cauterizing the opening of the fistula to pyriform apex may be useful to obliterate the internal opening of pyriform sinus.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
北大核心
2013年第12期646-650,共5页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
儿童
第四鳃裂畸形
诊断
外科手术
children
fourth branchial pouch sinus
diagnosis
surgical procedures
operative
