新生儿梨状窝瘘3例并文献复习

doi:10.6040/j.issn.1673-3770.0.2020.385

摘要/Abstract

摘要： 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。

关键词: 梨状窝瘘, 新生儿, 颈部肿物, 气体影

Abstract: 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.

Key words: Pyriform sinus fistula, Newborns, Neck mass, Gas shadow

中图分类号:

R762

杨红,滕以书,李兰,潘宏光,梁振江,韩赛红. 新生儿梨状窝瘘3例并文献复习[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 40-44.

YANG Hong, TENG Yishu, LI Lan, PAN Hongguang, LIANG Zhenjiang, HAN Saihong. Pyriform sinus fistula in neonates: a clinical report of 3 cases and literature review[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(4): 40-44.

参考文献

[1] James A, Stewart C, Warrick P, et al. Branchial sinus of the piriform Fossa: reappraisal of third and fourth branchial anomalies[J]. Laryngoscope, 2007, 117(11): 1920-1924. doi:10.1097/mlg.0b013e31813437fc.
[2] 董锦锦, 田秀芬. 先天性梨状窝瘘的诊断与治疗经验探讨[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(6): 444-447. doi:10.3760/cma.j.issn.1673-0860.2018.06.011. DONG Jinjin, TIAN Xiufen. Experience of diagnosis and treatment for congenital pyriform sinus fistula[J]. Chin J Otorhinolaryngol Head Neck Surg, 2018, 53(6): 444-447. doi:10.3760/cma.j.issn.1673-0860.2018.06.011.
[3] Watson GJ, Nichani JR, Rothera MP, et al. Case series: Endoscopic management of fourth branchial arch anomalies[J]. Int J Pediatr Otorhinolaryngol, 2013, 77(5): 766-769. doi:10.1016/j.ijporl.2013.02.007.
[4] 肖现民, 曾纪骅, 金百祥. 儿童梨状窝瘘的诊断与处理[J]. 中华外科杂志, 1997, 35(6): 354-356. XIAO Xianmin, ZENG Jihua, JIN Baixiang. Diagnosis and management of piriform sinus fistulae in children [J]. Chiese J Surg, 1997, 35(6): 354-356.
[5] Hosokawa T, Yamada Y, Sato Y, et al. Five neonatal cases of pyriform sinus fistula with cervical cystic lesion: a comparison between sonography and other modalities[J]. J Med Ultrason(2001), 2015, 42(4): 579-585. doi:10.1007/s10396-015-0641-5.
[6] Sheng QF, Lv Z, Xu WJ, et al. Differences in the diagnosis and management of pyriform sinus fistula between newborns and children[J]. Sci Rep, 2019, 9(1): 18497. doi:10.1038/s41598-019-55050-9.
[7] 李清明, 吴思恩, 黄素红, 等. 第三腮裂瘘管诊治6例并文献复习[J]. 山东大学耳鼻喉眼学报, 2016, 30(3): 61-64. doi:10.6040/j.issn.1673-3770.0.2016.041. LI Qingming, WU Sien, HUANG Suhong, et al. Diagnosis and treatment of the third branchial cleft fistula: a clinical report of 6 cases and literature review[J]. J Otolaryngol Ophthalmol Shandong Univ, 2016, 30(3): 61-64. doi:10.6040/j.issn.1673-3770.0.2016.041.
[8] 付营慧, 闵翔, 龙平, 等. 先天性梨状窝瘘的手术治疗和临床解剖学探讨[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(13): 984-987. doi:10.13201/j.issn.1001-1781.2018.13.006. FU Yinghui, MIN Xiang, LONG Ping, et al. The anatomic characteristics and surgical treatment of congenital pyriform sinus fistula[J]. J Clin Otorhinolaryngol Head Neck Surg, 2018, 32(13): 984-987. doi:10.13201/j.issn.1001-1781.2018.13.006.
[9] Nicoucar K, Giger R, Pope HG, et al. Management of congenital fourth branchial arch anomalies: a review and analysis of published cases[J]. J Pediatr Surg, 2009, 44(7): 1432-1439. doi:10.1016/j.jpedsurg.2008.12.001.
[10] 黄舒玲, 梁璐, 陈良嗣. 先天性梨状窝瘘的外科治疗进展[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(18): 1491-1494. doi:10.13201/j.issn.1001-1781.2016.18.017. HUANG Shuling, LIANG Lu, CHEN Liangsi. Progress in surgery treatment of congenital pyriform sinus fistula[J]. J Clin Otorhinolaryngol Head Neck Surg, 2016, 30(18): 1491-1494. doi:10.13201/j.issn.1001-1781.2016.18.017.
[11] 杜林芳, 路武豪, 娄卫华, 等. 内镜辅助下内瘘口封闭术治疗先天性梨状窝瘘管的疗效分析[J]. 中国耳鼻咽喉头颈外科, 2017, 24(12): 651-652. doi:10.16066/j.1672-7002.2017.12.013.
[12] Wang L, Sang J, Zhang Y, et al. Evaluation of endoscopic coblation treatment for obliteration of congenital pyriform sinus fistula[J]. Acta Otolaryngol, 2018, 138(6): 574-578. doi:10.1080/00016489.2017.1420916.
[13] Wang SC, He YZ, Zhang YM, et al. CO₂ laser cauterization approach to congenital pyriform sinus fistula[J]. J Pediatr Surg, 2018, 53(7): 1313-1317. doi:10.1016/j.jpedsurg.2017.06.020.
[14] Yanagisawa S, Oshio T, Kato M, et al. Endoscopic chemocauterization for pyriform sinus fistula in children[J]. Pediatr Int, 2017, 59(7): 807-811. doi:10.1111/ped.13294.
[15] 李玉晓, 何晓光, 王雨, 等. 第三、四鳃裂畸形的临床特征及疗效分析[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(15): 1201-1205. doi:10.13201/j.issn.1001-1781.2016.15.006. LI Yuxiao, HE Xiaoguang, WANG Yu, et al. Clinical characteristics and surgical management in patients with third and fourth branchial anomalies[J]. J Clin Otorhinolaryngol Head Neck Surg, 2016, 30(15): 1201-1205. doi:10.13201/j.issn.1001-1781.2016.15.006.
[16] Noriko Hamaguchi, Hajime Ishinaga, Kazuki Chiyonobu, et al. A case of pyriform sinus fistula with respiratory distress in the neonatal period[J]. Case Rep Otolaryngol, 2018, 2018: 1696875. doi:10.1155/2018/1696875.
[17] Derks LS, Veenstra HJ, Oomen KP, et al. Surgery versus endoscopic cauterization in patients with third or fourth branchial pouch sinuses: a systematic review[J]. Laryngoscope, 2016, 126(1): 212-217. doi:10.1002/lary.25321.

相关文章 15

[1]	朱晶,张睿,赵媛,李炀,樊孟耘,赵昱. 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[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 24-29.
[2]	朱晶,张睿,赵媛,李炀,赵昱. 新生儿咽旁间隙卡梅现象1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 55-59.
[3]	张丰珍,王桂香,赵靖,王华,段清川,李宏彬,黑明燕,翁景文,张杰. 新生儿双侧声带麻痹临床特点及预后分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 86-90.
[4]	曾斌, 吕丹, 任佳, 胡娟娟, 于凌昱, 卢欢, 杨慧. 喉显微外科技术在严重新生儿上气道梗阻中的应用[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 95-99.
[5]	龙婷,刘雨薇,王生才,张杰,李艳珍,张雪溪,刘悄吟,刘志勇,孙念,倪鑫. 内镜CO₂激光烧灼术治疗273例儿童先天性梨状窝瘘的临床分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 125-130.
[6]	盘琳琳, 孔令漪, 翟丰, 陈洁. 新生儿听力障碍常见危险因素及听力筛查方法研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 131-137.
[7]	窦倩雯, 田秀芬. 低温等离子射频消融治疗216例先天性梨状窝瘘的临床分析[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 43-49.
[8]	孙夏雨,陈建勇段茂利,杨军. 新生儿婴幼儿前庭功能发育和评估的研究进展[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 82-88.
[9]	王佳说, 郭星, 阎艾慧. 甲状腺乳头状癌颈淋巴结转移形成巨大囊性变的诊断总结[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 111-113.
[10]	王雅丛, 耿韶辉, 李艳涛, 王玉芳, 张红, 张婷婷, 张佳佳, 张炜. Retcam-3检查足月新生儿视网膜出血分级的初步探讨[J]. 山东大学耳鼻喉眼学报, 2015, 29(6): 78-81.
[11]	王国强, 赵春红, 霍红, 龚志云, 宋伟伟, 严丽霞, 李雪华, 王伟丽. 早产儿听力筛查结果及其听力障碍危险因素[J]. 山东大学耳鼻喉眼学报, 2015, 29(4): 7-10.
[12]	周晓娓, 王跃建, 段光荣, 虞幼军. 听力诊疗网络平台的开发[J]. 山东大学耳鼻喉眼学报, 2014, 28(6): 79-84.
[13]	刘志奇1，2，刘立思1，杨琨3 . 新生儿听力筛查11894例结果分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(2): 8-12.
[14]	张恩东，李大建，苗乐杰. 重症监护病房与母婴同室新生儿听力筛查比较[J]. 山东大学耳鼻喉眼学报, 2011, 25(2): 29-31.
[15]	杨琨,刘志奇,黄治物 . 正常新生儿226Hz及1000Hz探测音鼓室导抗测试[J]. 山东大学耳鼻喉眼学报, 2008, 22(5): 420-423 .

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed