摘要
目的 探讨儿童梨状隐窝瘘伴甲状软骨下角（ICTC）发育异常患者ICTC的形态学改变.方法 回顾分析1999年7月—2016年12月,复旦大学附属儿科医院采用胃镜辅助手术治疗的171例梨状隐窝瘘患儿的临床资料,其中8例（4.68%）于手术中发现瘘管周围结构异常,主要表现为ICTC发育异常.其中男7例,女1例;发病年龄为1天~15.4岁,平均5.8岁;手术年龄为23个月~15.5岁,平均8.6岁;瘘管均位于左侧.对8例患儿临床资料及手术记录进行回顾性分析,详细记录了瘘管与ICTC的关系,依据异常发育的ICTC形态对其进行分型研究,并根据分型不同进行相应的手术处理.结果 171例梨状隐窝瘘患儿术中伴有ICTC的发育异常者占4.68%（8/171）.其中ICTCⅠ型发育不良者（ICTC短而小）1例,瘘管远离下角穿出;Ⅱ型（ICTC与环状软骨融合）3例,瘘管自下角前或后穿出;Ⅲ型（下角圆钝型）4例,瘘管自下角尖端中心穿出.Ⅰ型患儿仅需将瘘管向近端分离,结扎切断即可;Ⅱ型者需剪开部分ICTC,并将其向内上方牵拉,以暴露瘘管,游离结扎;Ⅲ型亦需剪开部分下角,充分暴露瘘管并游离.8例患儿术后随访4~105个月,均无明显术后并发症,未见瘘管复发.结论 梨状隐窝瘘患儿可能伴有ICTC的发育异常.了解此解剖变异有助于术中识别瘘管及完整切除瘘管,并可减少手术创伤.
Objective To explore the morphological changes of inferior cornu of thyroid cartilage （ICTC） malformation in congenital pyriform sinus fistula （PSF） in children. Methods One hundred and seventy-one patients were diagnosed with PSF and performed endoscope-assisted surgical excision from July 1999 to December 2016. Abnormal structure around the fistula （ mainly for the ICTC） was found in 8 patients （ male 7, female 1） during operation. The age-of-onset ranged from the first day of birth to 15. 4 years （mean, 5. 8 years）. The average operative age was 8. 6 years （23 months to 15. 5 years）. All the fistulas located on the left side. Retrospective investigation of clinical history and operative records of the 8 cases was carried out. The relationship between the fistula and ICTC was recorded detailed. According to the anatomic variations of ICTC, fistula were specified, recorded and reviewed. The type of ICTC were classified based on the abnormal development, and made appropriate surgical management according to the classification. Results There were 8 patients with abnormal ICTC in 171 PSF patients （4. 68% ）. The anatomic variations of ICTC were classified into 3 types： type Ⅰ （dysplasia of ICTC）, 1 patient, the fistula is at some distance from the ICTC; type Ⅱ （cartilage fusion, ICTC was bonded with cricoid cartilage）, 3 patients the fistula penetrated through the anterior or posterior to ICTC; type Ⅲ （ obtuse ICTC）, 4 patients, the fistula penetrated through the center of the tip of ICTC. Separated the fistula proximally, and then ligation cutting for type Ⅰ. For type Ⅱ, we had to cut a little bit of ICTC and pull it inward and upward in order to expose the fistula adequately. For type Ⅲ, a little bit of ICTC also should be cut, and then separated the fistula. All the 8 patients remained asymptomatic for 4 to 105 months. No complications occurred and no fistula recurrence after surgery. Conclusions PSF in children could be accompanied with dysgenesis of ICTC. Understanding the anatomic variations is helpful for identifying the fistula and excising completely in operation, and decreasing the operative trauma at the same time.
出处
《中华解剖与临床杂志》
2017年第5期387-391,共5页
Chinese Journal of Anatomy and Clinics
关键词
梨状隐窝
瘘
儿童
甲状软骨
发育异常
Pyriform Sinus
Fistula
Child
Thyroid cartilage
Dysplasia
