新生儿梨状窝瘘3例并文献复习

目的 总结新生儿梨状窝瘘的临床特点及诊治经验。 方法 对2018年1月至2020年9月诊治的3例新生儿梨状窝瘘的临床表现、辅助检查、治疗方法及预后进行回顾性分析。 结果 3例梨状窝瘘患儿中男孩2例,女孩1例,其中1例男性患儿出生后10 d即被发现颈部肿物而就诊,余两例患儿产前检查被发现;3例梨状窝瘘均在左侧;3例病例颈部B超均显示颈部囊性团块,囊壁厚,囊腔内显示点状气体样回声,颈部增强CT提示囊腔内见气液平。3例患儿均行手术治疗,其中两例新生儿术中切除肿物后明确找到瘘管,予以顺利结扎,梨状窝处内瘘口未予以特殊处理,另1例颈部肿物予以切开引流后内镜下激光烧灼内瘘口。术后随访5个月至两年,暂未发现复发或反复感染病例。 结论 新生儿常以出生后发现无痛性颈部肿物或产前发现颈部占位为表现,颈部B超及颈部CT检查示肿物中常可见气体影,出生后肿物进行性增大,这时需高度怀疑梨状窝瘘可能。手术治疗是根除梨状窝瘘的根本方法,内镜下激光烧灼内瘘口和颈部肿物切除后高位结扎瘘管均未见复发。

Pyriform sinus fistula in neonates: a clinical report of 3 cases and literature review

Objective To summarize the clinical characteristics, diagnosis and treatment of pyriform sinus fistula in neonates. Methods The clinical manifestation, auxiliary examination, treatment and prognosis of 3 cases of pyriform sinus fistula in our department were analyzed retrospectively between January 2018 and June 2020. Results 3 cases of pyriform sinus fistula were reported, there were 2 boys and 1 girl. One male child was found to have neck tumor 10 days after birth, and the other two cases were found in prenatal examination; 3 cases of pyriform sinus fistula were all on the left side; 3 cases of neck B-ultrasound showed cystic mass in the neck, with thick wall, punctate gas echo in the cavity, and enhanced CT showed gas-liquid level in the cavity. All the 3 cases were treated by operation. Two of them were founded the fistula after removing the tumor and ligated it smoothly. The internal fistula of pyriform sinus was not treated specially. The other one was cut and drained and then cauterized by laser under endoscope. The patients were followed up for 5 months to 2 years after surgery. No recurrence or repeated infection was found. Conclusion The neonatal pyriform sinus fistula usually starts with painless neck mass or is founded in prenatal examination. B-ultrasound and CT examination of the neck showed that the masses were often seen Gas shadow, progressive enlargement of tumor after birth, At this time, we need to highly suspect the pyriform sinus fistula. Surgical treatment is the fundamental method to eliminate the pyriform sinus fistula. No recurrence was found in the laser cauterization of the internal fistula and high ligation of the fistula after removal of the neck mass.