内镜下射频消融治疗儿童急性感染期梨状窝瘘

目的　观察显微支撑喉镜下射频消融治疗儿童急性感染期梨状窝瘘的临床疗效。方法　回顾性分析2017年1月~2019年10月我科收治的21例急性感染期梨状窝瘘患者的临床资料,所有患儿均在全麻下行显微支撑喉镜下射频消融封闭梨状窝瘘内瘘口,同时行颈部脓肿切开引流术。术后留置胃管2 w,抗生素治疗1～2 w,颈部换药3 w内痊 愈。观察分析患儿术后疗效、复发率及并发症等情况。结果  术后随访3～36个月,3例患儿出现一过性声嘶,术后3个月内恢复正常。所有患儿梨状窝瘘内瘘口1次封闭,无复发,无咽瘘、呛咳、喉返神经损伤、大出血等并发症。结论　内镜下射频消融术联合颈部脓肿切开引流术,推荐作为急性感染期梨状窝瘘的首选治疗方案。     

Minimally invasive treatment of neonatal congenital pyriform sinus fistula with infection: a case report北大核心CSCD

本文报道了1例新生儿先天性梨状窝瘘的患儿。患儿7 d龄,因“气促、喘憋7 d”发现左侧颈部肿物,血常规提示白细胞升高,以中性粒细胞升高为主,考虑左侧颈部肿物为“颈部感染伴脓肿”可能性大。经过多学科讨论后先予左侧颈部穿刺引流,后在支撑喉镜下予针状电刀烧灼左侧梨状窝瘘口,封闭瘘口后观察未再见分泌物流出,诊断为左侧先天性梨状窝瘘,左侧鳃裂瘘管伴感染,左侧颈部脓肿。术后患儿症状改善,随访5个月无不适。     

新生儿先天性梨状窝瘘伴感染微创治疗1例

本文报道了1例新生儿先天性梨状窝瘘的患儿。患儿7 d龄, 因"气促、喘憋7 d"发现左侧颈部肿物, 血常规提示白细胞升高, 以中性粒细胞升高为主, 考虑左侧颈部肿物为"颈部感染伴脓肿"可能性大。经过多学科讨论后先予左侧颈部穿刺引流, 后在支撑喉镜下予针状电刀烧灼左侧梨状窝瘘口, 封闭瘘口后观察未再见分泌物流出, 诊断为左侧先天性梨状窝瘘, 左侧鳃裂瘘管伴感染, 左侧颈部脓肿。术后患儿症状改善, 随访5个月无不适。     

可视喉镜下梨状窝瘘内口低温等离子封闭术的初步探讨

目的:探讨可视喉镜下梨状窝瘘内口低温等离子封闭术的手术效果.方法:回顾性分析2019年3月-2021年8月在南京医科大学附属儿童医院耳鼻咽喉头颈外科行可视喉镜下梨状窝瘘内口低温等离子封闭术的29例先天性梨状窝瘘患儿的临床资料.19例行梨状窝瘘探查十瘘口封闭术,6例行梨状窝瘘探查十瘘口封闭术十颈部脓肿切开引流,4例颈部质...     

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。     

源于梨状窝瘘的颈深部脓肿

梨状窝瘘系发生于梨状窝的鳃缘性内瘘,起源于第3或第4鳃囊.内口多位于梨状窝侧壁,左侧多见.我科2002年6月～2006年6月共收治5例梨状窝瘘患者.     

梨状窝异位甲状旁腺1例及文献复习

目的:探讨梨状窝异位甲状旁腺的诊断及治疗.方法:回顾性分析1例梨状窝异位甲状旁腺患者的临床资料并复习有关文献.结果:本文报告1例甲状旁腺腺瘤;有关报道梨状窝发现甲状旁腺组织2例、甲状旁腺腺瘤1例、甲状旁腺增生3例.结论:梨状窝异位甲状旁腺较罕见、易误诊,了解甲状旁腺部位的多变性有助于梨状窝异位甲状旁腺及腺瘤的诊断和治疗.     

内镜下等离子射频消融术治疗儿童先天性梨状窝瘘232例

目的 探讨儿童先天性梨状窝瘘的诊断、手术适应证及内镜下低温消融术的疗效。方法 回顾分析郑州大学第一附属医院内镜下低温消融术治疗的232例儿童先天性梨状窝瘘的临床资料。结果 217例(93.5%)为左侧梨状窝瘘,14例(6.0%)为右侧梨状窝瘘,1例(0.4%)双侧梨状窝瘘。男女比约1.1∶1.0。232例均行内镜下梨状窝瘘口低温消融术。术后复发17例(7.3%)、声音嘶哑12例(5.2%),均无呛咳、食管损伤或咽瘘。结论 内镜下梨状窝瘘口低温消融术治疗先天性梨状窝瘘具有微创、并发症较少、复发率低等优点,是治疗先天性梨状窝瘘的首选手术方案之一。     

综合疗法与放射治疗在梨状窝癌疗效的比较

梨状窝部位隐蔽,该处的肿瘤早期不易被发现。由于淋巴流丰富,其颈部淋巴结转移率高达66～77％。梨状窝肿瘤除了直接向周围侵犯外,还可经粘膜下淋巴管扩散到颈部食管。长期以来,梨状窝癌的治疗效果很差。为了寻求较好的治疗方法,作者们对51例梨状窝癌进行了回顾性分析。所有病例至少追踪5年或随访至死亡。这51     

先天性梨状窝瘘治疗新进展

随着对于先天性梨状窝瘘的诊治认识的深入,相关的诊治方法也有不断地改进。本文讨论了近年来先天性梨状窝瘘手术治疗的新技术、新进展,分析各种治疗方法的演变和进展,手术方案逐步向微创、并发症少、美容效果好方向进行转变。     

等离子射频辅助双侧声带后端切断术治疗双侧声带麻痹导致的上气道梗阻患者13例

目的 评估内镜下等离子射频辅助双侧声带后端切断术治疗双侧声带麻痹导致上气道梗阻患者的疗效。 方法 回顾性分析13例双侧声带麻痹导致的上气道梗阻患者的病例资料,其中男6例、女7例,27~73岁,所有患者均接受等离子射频辅助双侧声带后端切断术。总结评估该手术的临床疗效。 结果 13例随访时间1年1个月~2年11个月,所有患者无严重并发症发生。一次拔管率为84.44%(10/13),二次手术拔管率为88.89%(11/13),拔管时间1~3个月,中位数1个月,上气道梗阻均未复发。 结论 内镜下等离子射频辅助双侧声带切断术操作简单、手术风险小,同时治疗双侧声带麻痹效果可靠,是双侧声带麻痹导致上气道梗阻的有效治疗方法之一,也可作为其他治疗失败的补救治疗措施。     

先天性梨状窝瘘管的诊断与治疗

目的 探讨先天性梨状窝瘘管(congenital pyriform sinus fistula,CPSF)的临床表现和治疗原则。方法 对2007年1月至2011年1月经手术确认连接梨状窝与甲状腺叶瘘管的7例CPSF患者资料进行分析。患者均表现为复发性左侧颈部低位脓肿或急性化脓性甲状腺炎,所有患者均有误诊病史,病程3 ～11年,均曾数次行切开引流或外科探查。急性感染期患者脓肿切开引流,炎性反应消退后进行检查和根治性手术。结果 炎性反应静止期CT检查,均可见左侧甲状腺叶深面及其周围间隙瘢痕组织增生;6例患者行X线钡餐检查,5例可见源于梨状窝的瘘管。4例患者术前行直达喉镜检查,3例可见位于梨状窝尖部附近的瘘口。手术切除瘘管及左侧部分甲状腺叶,保护喉返神经。术后恢复顺利,未出现永久性喉返神经麻痹或甲状腺功能低下等并发症。随访5～40个月,未见复发。结论 对于有反复发作下颈部脓肿病史的患者,尤其位于左侧者,应高度怀疑CPSF的存在,X线钡餐和CT检查是有效的诊断方法,完整切除瘘管及受累甲状腺叶可治愈CPSF。     

Thyroid abscess with branchial anomaly

The third arch branchial fistula is a rare congenital abnormality that presents as an inflammatory process in the anterior neck, often in the region of the left lobe of thyroid. Incomplete fistula is not an uncommon finding extending from base of pyriform sinus to the thyroid or perithyroidal space, which predisposes to recurrent suppurative thyroiditis during episodes of upper respiratory infection. Complete fistula of third arch is extremely uncommon, especially of congenital origin. A 10-year-old male child presented with a small opening in the anterior neck since birth, with a swelling around it. Computerized tomography revealed a patent tract from neck skin to base of pyriform sinus. Total excision of the tract up to the left pyriform sinus with hemithyroidectomy was performed. There was no recurrence at 22 months of follow-up.     

第三腮裂瘘管诊治6例并文献复习

目的 探讨第三腮裂瘘管的临床特征及治疗方法。 方法 回顾性分析6例第三腮裂瘘管患者的临床资料,包括术前检查、手术治疗过程及疗效,并复习相关文献。行多层螺旋CT及瘘管碘造影剂造影,能显示瘘管走行及内瘘口位于梨状窝,全麻下应用功能性颈清扫术式彻底切除瘘管,术后切口一期愈合。 结果 6例中误诊3例,包括颈部脓肿2例、亚急性甲状腺炎1例。随访10个月以上无复发。 结论 多层螺旋CT及瘘管碘造影剂造影可显示瘘管全程,诊断准确、简便,为彻底切除病变提供安全保障。功能性颈清扫术能切除瘘管全程,是一种安全、有效的治疗手段。     

Fourth branchial pouch sinus with recurrent deep cervical abscesses successfully treated with trichloroacetic acid cauterization

A previously healthy 13-year-old girl presented with a left-sided deep cervical abscess. A CT scan demonstrated an abscess in the lower neck, anterior to the common carotid artery. Treatment with i.v. antibiotics and incision drainage resolved the condition. A recurrence of the abscess 7 months later was treated identically. Further investigations with MRI showed a 2-3-mm wide, 10-mm long structure in the lateral aspect of the left thyroid lobe. A barium radiograph depicted a narrow, 20-mm long fistula originating from the left pharynx. At endoscopy a 2-3-mm wide opening was found at the left pyriform sinus apex. This, together with the radiological findings, verified the diagnosis of a 4th branchial pouch sinus. The recurrence of the abscess may have been due to contamination by infectious pharyngeal secretions. Although radical surgical excision is traditionally recommended for this condition a non-invasive treatment, namely chemocauterization with 40% trichloroacetic acid (TCA), was chosen in this case. Three cauterizations were needed to close the pyriform sinus opening. To date (Month 14) there has been no recurrence of the cervical abscesses. TCA chemocauterization seems to be a safe first-line treatment for patients with a pyriform sinus fistula.     

Pyriform sinus fistula: management with chemocauterization of the internal opening

A branchial remnant originating in the pyriform sinus causes a recurrent fistula or abscess in the neck. In spite of excision, recurrence may result from inadequate removal of the fistula tract. We attempted chemocauterization of the internal opening of the fistula tract with trichloroacetic acid (TCA) on direct endoscopy. This is a 6-year review of 18 patients with pyriform sinus fistula. Medical history, barium esophagography, computed tomography scans, operative findings, and treatment results were analyzed. By direct endoscopy, all patients were found to have a fistula opening in the pyriform sinus, exclusively on the left side. In only 9 patients, the fistula tract was identified by barium esophagography before operation. Computed tomography revealed a suspicious fistula tract originating from the pyriform sinus in 8 of 10 patients. Sixteen patients were initially managed by TCA chemocauterization. There were no serious intraoperative or postoperative complications. Four patients had recurrent masses, which were managed by simple excision in 2 patients and repeated TCA cauterization in the other 2 patients with unobliterated internal openings. We recommend barium swallow study and direct endoscopy for all patients presenting with a recurrent lateral neck abscess, especially on the left side. Our results suggest that initial chemocauterization of the internal opening can be a reasonable alternative procedure for the management of pyriform sinus fistula.     

头颈部神经鞘瘤23例临床分析

目的：探讨头颈部神经鞘瘤的临床特征，以提高对头颈部神经鞘瘤的诊治水平。方法：23例均行手术切除，其中颈侧切开切除颈部肿瘤15例，鼻侧切开切除鼻腔肿瘤1例，经口径路切除肿瘤3例，2例面神经鞘瘤分别经中耳乳突中后颅窝联合径路和乳突根治径路切除，1例位于梨状窝的神经鞘瘤在食管镜下钳取完整取出，1例气管内神经鞘瘤行气管切开切除。结果：20例术后随访3个月－7年，19例无复发；1例鼻腔、鼻窦肿瘤术后3年复发。1例术后出再霍纳征，2个月后消失，1例术后出现声嘶。结论：神经鞘瘤术前诊断困难，确诊有赖于病理检查；一旦确诊应尽早手术完整摘除，尽可能保护神经功能，避免并发症的发生。