内镜下低温等离子消融治疗不同炎症分期先天性梨状窝瘘45例

目的 观察内镜下低温等离子消融治疗不同炎症分期儿童先天性梨状窝瘘的疗效及并发症发生情况,探讨手术适应证的选择及术后治愈标准判断。 方法 将近3年来收治的45 例先天性梨状窝瘘临床资料进行回顾性分析,根据临床特点将其分为炎症早期、脓肿期和静止期,观察低温等离子内瘘口消融封闭术后的疗效。 结果 所有患儿术后随访6个月~3年,治愈33例(占比73.3%),其中17例患儿完成二次内镜下探查,内瘘口均一次性闭合且术后B超检查未见异常;16例患儿未接受二次手术探查,仅B超随访,未见异常;好转11例(占比24.4%),均未接受二次内镜手术探查,术后B超随访可见微管残留,但随访半年以上无临床症状发作;未愈1例(占比2.3%),该例完成内镜探查,内瘘口已封闭,B超复查示微管残留,术后7个月患侧颈部再次感染,抗感染治疗后痊愈,随访一年未见反复,仍在随访中。炎症早期患儿4例,术后短期内出现颈部脓肿2例,切开排脓后痊愈;脓肿期患儿15例,术后随访期间未再出现颈部感染;炎症静止期患儿26例,术后7个月患侧颈部再次肿胀1例,抗感染治疗后痊愈。术后声音嘶哑1例(静止期),随访1个月恢复,其余无并发症出现。 结论 内镜下低温等离子消融治疗炎症静止期和急性感染期的先天性梨状窝瘘,疗效确切,安全微创,推荐作为初治先天性梨状窝瘘方法首选。

Endoscopic plasma ablation in 45 cases of congenital piriform sinus fossa fistula with different degrees of inflammation

Objective To observe the postoperative efficacy and complications of endoscopic low-temperature plasma ablation for congenital piriform sinus fossa fistula(CPSF)in children with different inflammatory stages and explore the selection of surgical indications and the judgment of postoperative cure criteria. Methods The clinical data of 45 patients with congenital pyriform sinus fistula treated in our department in the past 3years were retrospectively analyzed. According to the clinical characteristics, it was divided into early infection, abscess, and inflammatory quiescence stages. All children were treated with low-temperature plasma under endoscopic guidance. The curative efficacy was observed. Results All children were followed up for 6 months to 3 years. A total of 33 cases(73.3%)were cured. In 17 cases, the secondary endoscopic exploration was completed, the internal fistula was closed, and no abnormalities were found on a postoperative B-ultrasound examination. Sixteen children underwent only B-ultrasound follow-up and no second surgical exploration, and no abnormalities were noted. Eleven cases(24.4%)improved. None underwent a second endoscopic exploration, and postoperative B-ultrasound follow-up showed microtubule residue but no clinical symptoms during more than 6 months of follow-up. One case(2.3%)was not cured. In this case, endoscopic exploration was completed, the internal fistula was closed, and a B-ultrasound reexamination showed microtubule residue. The neck of the affected side became re-infected 7 months postoperative, but it recovered after antibiotic treatment. The patient was followed up for 1 year without recurrence and remains under surveillance. Four children had early inflammation; of them, 2 had neck abscesses soon after surgery that were cured after incision and drainage. Among 15 cases in the abscess stage, no neck infection occurred during postoperative follow-up. Among the 26 children in the inflammatory quiescence stage,1 had recurrent neck swelling on the affected side at 7 months postoperative that recovered after anti-infective treatment. One patient(inflammatory quiescence stage)developed hoarseness postoperatively and recovered after 1 month of follow-up, while the rest had no complications. Conclusion Endoscopic low-temperature plasma ablation for the treatment of CPSF fistula in the period of quiescent inflammation and acute infection is effective, safe, and minimally invasive, making it the first choice for the initial treatment of CPSF.