儿童梨状窝瘘反复发作的原因与胃镜辅助手术

目的分析儿童梨状窝瘘反复发作的原因，介绍胃镜辅助手术方法及其优越性。方法12例患儿。男8例，女4例，年龄2．5～9岁；曾行左颈部瘘管或囊肿切除术8例，左颈部反复感染者4例；吞钡造影、B超、CT、同位素扫描等检查诊断为梨状窝瘘。12例均行胃镜辅助瘘管切除术。取此前未经胃镜辅助而直接手术的8例临床资料作对照。结果经胃镜辅助切除瘘管，平均手术时间1h 35min，术后恢复顺利，随访无复发。对照组手术时间长，2例复发。结论缺乏对梨状窝瘘胚胎发生和病理过程的了解是治疗失误的主要原因，胃镜辅助手术是一种简便、有效的治疗手段。     

新生儿梨状窝瘘的诊治特点

目的 阐述新生儿梨状窝瘘这一少见疾病的诊治特点.方法 收集我院2001年7月至2010年1月收治的9例新生儿梨状窝瘘病例,分析其发病年龄、临床表现、辅助检查及临床治疗经过,总结其诊治特点和预后.结果 9例梨状窝瘘均为左侧.均以颈部囊性肿块就诊.8例为新生儿时期出现症状,1例为产前发现.5例颈部增强CT提示肿块中含有气体.新生儿时期手术治疗7例.随访时间6个月至9年,患儿临床均无反复感染或复发迹象.结论 新生儿的梨状窝瘘临床表现不同于儿童,常因颈部无痛性、囊性肿块就诊,缺少反复脓肿切开引流史.超声或CT检查中常可发现囊肿中含有气体影.新生儿早期手术瘘管结扎率高,部分需要胃镜辅助.治疗安全性可靠,术后复发率低且预后良好.     

新生儿梨状窝瘘的诊治特点

目的 阐述新生儿梨状窝瘘这一少见疾病的诊治特点.方法 收集我院2001年7月至2010年1月收治的9例新生儿梨状窝瘘病例,分析其发病年龄、临床表现、辅助检查及临床治疗经过,总结其诊治特点和预后.结果 9例梨状窝瘘均为左侧.均以颈部囊性肿块就诊.8例为新生儿时期出现症状,1例为产前发现.5例颈部增强CT提示肿块中含有气体.新生儿时期手术治疗7例.随访时间6个月至9年,患儿临床均无反复感染或复发迹象.结论 新生儿的梨状窝瘘临床表现不同于儿童,常因颈部无痛性、囊性肿块就诊,缺少反复脓肿切开引流史.超声或CT检查中常可发现囊肿中含有气体影.新生儿早期手术瘘管结扎率高,部分需要胃镜辅助.治疗安全性可靠,术后复发率低且预后良好.     

儿童颈部梨状窝瘘诊治进展

梨状窝瘘多以小儿反复发作的单侧（左侧为主）颈部炎性脓肿或急性化脓性甲状腺炎等症状就诊,以往在治疗上多为反复颈部脓肿切开引流及联合多种抗生素对症缓解症状或是开放性常规分离瘘管手术寻求根治,但复发率较高。该文通过总结近年梨状窝瘘相关诊断和治疗进展,旨在强调对于疑似患儿需及时行超声、CT、上消化道钡餐等检查,必要时做内镜检查,治疗上在非急性期以内镜辅助下导管置入或亚甲蓝内口注射行梨状窝瘘切除术可明显减少复发率。     

内镜辅助梨状窝瘘切除术

梨状窝瘘是一种少见的颈部鳃源性疾病,主要表现为反复发作的颈部感染或类似化脓性甲状腺炎表现,临床及易误诊。治疗的关键是彻底切除瘘管,但由于局部反复感染,瘘管及其周围组织致密粘连,术中瘘管难以寻找,或切除不完全,术后易复发。采用内镜辅助寻找瘘管能有效提高手术成功率。     

个体化术式选择治疗儿童梨状窝瘘的效果分析

目的:探讨个体化术式选择治疗儿童梨状窝瘘的效果。方法:选取2015年6月至2019年11月河南省人民医院小儿外科收治的43例梨状窝瘘患儿,左侧41例,右侧2例;炎症控制期27例,急性炎症期16例;根据个体病情选择低温等离子射频消融、梨状窝瘘切除、颈部脓肿切开引流等术式或联合术式,观察术后并发症及复发情况。结果:43例梨...     

儿童甲状舌管囊肿及瘘术后复发的原因和预防

目的 探讨甲状舌管囊肿及瘘术后复发的原因和预防措施，减少手术复发率。方法 向43例甲状舌管囊肿及瘘管(含11例复发者)中注入美蓝，以判定囊肿及瘘的范围、分支及走行，彻底切除囊肿及瘘管，切除舌骨中段和其附着的组织及舌骨以上至舌盲孔之间的一段柱状组织。结果 甲状腺囊肿23例，甲状腺舌管瘘6例，囊肿并瘘管2例，囊肿／6并慢性炎症改变12例。43例行囊肿及瘦根治性切除术，40例随访1年以上，均无复发。结论 预防甲状舌管囊肿及瘦术后复发的关键在于明确囊肿及瘦的范围，轻柔操作，仔细解剖，认真辨认，避免撕断而遗留囊肿及瘘管组织。     

"Massive hemoptysis" and shock after fever and cough北大核心CSCD

11岁男性患儿,因间断发热15 d,咳嗽10 d,“咯血”7 d入院。患儿15 d前以发热咳嗽起病,伴左侧颈部疼痛,抗生素治疗有效。病程中突然出现大“咯血”致休克,后经纤维支气管镜检查发现左侧梨状窝内瘘口并持续渗血,结合颈部及血管影像学检查考虑为先天性梨状窝瘘感染并颈部脓肿致颈内静脉受损血栓形成,通过低温等离子消融梨状窝瘘封闭术治疗后好转,随访1年半未反复。检索文献未发现梨状窝瘘感染引起大出血休克报道,该文总结此例患儿的临床特点及诊治经过,为早期诊断该类疾病及其并发症防治提供参考依据。     

小儿先天性动静脉瘘的诊治

目的 探讨对小儿先天性动静脉瘘(congenital arteriovenous fistula，CAVF)的诊断与治疗。方法 本组共收治15例CAVF患儿，男6例、女9例，年龄8～14岁。对全部患儿行多普勒超声，动脉造影或MRA检查。发现病变局限者5例，病变范围广泛性者10例，病变大多发生于四肢。动脉造影显示：动静脉之间出现瘘支；动脉分支多而紊乱，可呈碗蜒扭曲状，病变多为弥漫性；静脉象早期出现。对11例患儿行手术治疗，其中4例局限性病变者行病灶切除。对7例病变广泛者行1或多次减量手术，方法是沿动脉主干切除瘘支与病变组织，对分流量大又无法切除的病变组织予以缝扎，以减少分流量。对5例患儿行栓塞治疗(其中2例为术前栓塞治疗以减少手术出血)。1例未治疗。结果 随访1～6年。5例局限性患儿中3例治愈，2例病情控制。10例广泛性病变中，5例病情好转或控制，5例病情仍继续发展。结论 影像学检查是CAVF诊断与治疗的依据。CAVF治疗困难。尤其对广泛性病变者，无论手术或栓塞治疗疗效均欠理想。但对小儿CAVF应尽早治疗，这样可控制病情发展．防止并发症发生。     

经口内镜下低温等离子微创治疗儿童先天性梨状窝瘘

目的:探讨经口内镜下低温等离子封闭内瘘口治疗儿童梨状窝瘘的手术方法及预后。方法:收集2018年1月至2020年4月河南省儿童医院收治的31例先天性梨状窝瘘患儿的临床资料。其中,男17例,女14例,年龄范围为21 d至9岁,中位年龄为3岁2个月。31例患儿均为左侧发病,16例患儿有脓肿切开引流史。术前CT检查显示脓肿内有...     

Recurrent suppurative thyroiditis due to pyriform sinus fistula: a case report

Acute suppurative thyroiditis is a rare disease, particularly in childhood. We present a case with recurrent acute suppurative thyroiditis due to a pyriform sinus fistula originating from the fourth branchial pouch. The typical symptoms of a piriform sinus fistula are recurrent left-sided pain and swelling of the neck with signs of acute bacterial inflammation. Diagnosis should be made by high resolution ultrasound, barium meal studies and endoscopic examination. During acute exacerbations treatment with antibiotics is indicated, but permanent cure can only be attained by complete fistulectomy.     

Suspicion of prenatal pyriform sinus cyst and fistula: a case report

There has been no report describing suspected prenatal pyriform sinus (PS) cyst and fistula. We report a case suspected by prenatal ultrasonography and fetal MRI. A large cystic mass was found in the left neck of the fetus. After the baby was born, preoperative laryngoscopic catheterization of the fistula tract was used to confirm the diagnosis and greatly facilitated the identification and excision of the PS cyst and fistula.     

Branchial fistula: CT manifestations

A patient with a recurrent left neck abscess was found to have a branchial fistula from the pyriform sinus. This uncommon anomaly was demonstrated by CT and barium swallow. The embryology, pathology and clinical features of this lesion are discussed and contrasted with those of the branchial cyst.     

Acute suppurative thyroiditis in children

BACKGROUND: Acute suppurative thyroiditis in children is rare and is often related to a pyriform sinus fistula or thyroglossal duct remnant, especially when it is recurrent. METHODS: From January, 1985, through December, 2000, 15 children with acute suppurative thyroiditis were treated. Their clinical, laboratory and radiologic findings were reviewed and analyzed. RESULTS: There were 8 girls and 7 boys, with a mean age at diagnosis of 6.1+/-2.9 years (range, 1.5 to 9.8). A thyroid mass was present on the left in 13 and on the right in 2 (P < 0.05). Fever, neck pain and swelling were the most common symptoms and signs. Seven patients (46.7%) had recurrent disease. Needle aspiration for Gram stain and bacterial cultures were done, and pathogenic organisms were identified on culture in 8 patients but were found only on Gram stain in 2 patients. In one-half of the patients with positive cultures, mixed pathogens were found. The most common organisms isolated were streptococcal species (50%). Barium esophagography was performed in all patients, and 5 (33.3%) had a pyriform sinus fistula on the left. Only 1 of the recurrent patients had a fistula. Thyroid scans were performed in 13 patients, of whom 12 (92.3%) had decreased radioactive uptake. Thyroid function tests were normal in all 15. CONCLUSIONS: Acute suppurative thyroiditis is usually caused by oropharyngeal flora, resulting in mixed pathogens on culture. Broad spectrum antibiotics should be given once cultures have been obtained. Imaging studies might be helpful in the diagnosis of acute suppurative thyroiditis.     

子宫外产时处理胎儿颈部巨大占位的临床初探

目的 探讨子宫外产时处理(EXIT)技术治疗胎儿颈部巨大肿块的临床应用.方法 2007年9月至2010年2月,选择性对4例产前诊断颈部巨大占位合并羊水过多、气管受压/受压不明确的胎儿实施EXIT技术.分析其病因、生后气管受压、术前依赖机械通气等情况,初步评估EXIT技术对胎儿颈部巨大占位预后的影响.结论 男女比例3:1,足月,择期分娩.3例术前依赖机械辅助通气,增强CT提示气管明显受压及推移,最严重者出现口咽腔受压变狭窄.3例患儿新生儿期手术治疗,1例未手术.诊断肠源性囊肿1例、淋巴管瘤2例及梨状窝瘘1例.随访6~36个月预后良好.结论 胎儿颈部占位以淋巴管瘤、畸胎瘤多见,其他如肠源性囊肿、梨状窝瘘或食管重复畸形等少见.多数颈部占位可对气道产生压迫及推移,严重者影响呼吸.EXIT技术可为胎儿出生即刻提供良好通气状况,最大程度减少缺氧发生.颈部占位胎儿接受EXIT技术分娩,多数预后良好,转归令人满意.

Abstract：

Objective To discuss the role of EXIT(ex-utero intrapartum treatment) procedure in the treatment of fetal neck mass.Methods Form 2007,9 to 2010,2,4 fetus were selected,those diagnosed neck huge mass with polyhydramnios in prenatal period.After term pregnancy,they were delivered by EXIT procedure in Obstetrics & Gynecology Hospital and follow-up in our Children's hospital.All information of the neck mass,mass of air pressure on the circumstances,the preoperative on mechanical ventilation was recorded,and the effect and prognosis of these patients were evaluated.Results Boy: girl: 3:1.They all delivered by EXIT procedure after full term.Three cases depended on the mechanical ventilation before the operation.Enhance CT showed trachea obviously compressed and lapsed.The most serious patient was found the pharynx under pressure.Those 3 cases had operations in neonatal period.The other one case had no operation and follow-up in clinic department.Four cases were diagnosed as enterogenous cyst 1 case,lymphangioma 2 cases and pyriform sinus fistula 1 case.Conclusions EXIT procedure would provide a ventilation pathway for baby with reduced hypoxia.Fetal with neck mass delivered by EXIT procedure will get good prognosis,the treatment results will be satisfactory.