山东大学耳鼻喉眼学报 ›› 2021, Vol. 35 ›› Issue (2): 39-45.doi: 10.6040/j.issn.1673-3770.1.2020.092

• 临床研究 • 上一篇    下一篇

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

窦倩雯,田秀芬   

  1. 郑州大学第一附属医院 耳鼻咽喉头颈外科, 河南 郑州 450052
  • 发布日期:2021-04-20
  • 通讯作者: 田秀芬. E-mail:xiufen.tian@126.com
  • 基金资助:
    河南省高等学校重点科研项目(19A320082)

Clinical analysis of 216 cases of congenital pyriform sinus fistula treated by radiofrequency ablation

DOU Qianwen, TIAN Xiufen   

  1. Department of Otorhinolaryngology & Head and Neck Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
  • Published:2021-04-20

摘要: 目的 探讨先天性梨状窝瘘的诊断方式,评估内镜低温等离子射频消融封闭内瘘口治疗先天性梨状窝瘘的疗效。 方法 收集首次接受经内镜低温等离子射频消融治疗的216例先天性梨状窝瘘患者资料并回顾分析。 结果 216例中90.7%位于左侧,8.3%位于右侧,仅1.0%位于双侧;男女比约1.18∶1,年龄从23 d~66岁不等。失访8例,平均随访15个月, 出现术后声嘶17例(8.2%),复发12例(5.8%),均无感染、呛咳或食管损伤。 结论 低温等离子射频消融封闭内瘘口可作为先天性梨状窝瘘的首选手术方式。

关键词: 梨状窝瘘, 腮裂畸形, 射频消融, 等离子, 颈部肿块, 急性化脓性甲状腺炎

Abstract: Objective Congenital pyriform sinus fistula(CPSF)is a rare parotid source disease. It is easily misdiagnosed as a simple abscess in the neck in clinical practice. In the past, neck fistulectomy was usually the treatment of choice; however, it was traumatic, and the fistula could not be eliminated completely, thus leading to recurrence. Our study aimed to investigate congenital pyriform sinus fistula and evaluate the therapeutic effect of radiofrequency ablation in the treatment of congenital pyriform sinus fistula. Methods The data of 216 patients with congenital pyriform sinus fistula treated by radiofrequency ablation between March 2013 and May 2019 were collected and analyzed retrospectively. Results Among the 216 patients, the ratio of males to females was approximately 1.18∶1, and 90.7% of the cases were left-sided, 8.3% were right-sided, and only 1.0% were bilateral. The age range of the patients was 23-66 years. Eight patients were lost to follow-up, with an average follow-up of 15 months. Among 208 patients after coblation, 17 cases(8.2%)had postoperative hoarseness, 12 cases(5.8%)had recurrence, and there was no infection, irritating cough, or esophageal injury. Conclusion Radiofrequency ablation is the first choice for the treatment of congenital pyriform sinus fistula.

Key words: Pyriform sinus fistula, Branchial fissure deformity, Radiofrequency ablation, Plasma, Neck mass, Acute suppurative thyroiditis

中图分类号: 

  • R726.5
[1] Jordan JA, Graves JE, Manning SC, et al. Endoscopic cauterization for treatment of fourth branchial cleft sinuses[J]. Arch Otolaryngol Head Neck Surg, 1998, 124(9):1021-1024. doi:10.1001/archotol.124.9.1021.
[2] Garrel R, Jouzdani E, Gardiner Q, et al. Fourth branchial pouch sinus: from diagnosis to treatment[J]. Otolaryngol Head Neck Surg, 2006, 134(1):157-163. doi:10.1016/j.otohns.2005.05.653.
[3] Nicollas R, Guelfucci B, Roman S, et al. Congenital cysts and fistulas of the neck[J]. Int J Pediatr Otorhinolaryngol, 2000, 55(2):117-124. doi:10.1016/s0165-5876(00)00384-0.
[4] Mukerji SS, Parmar H, Ibrahim M, et al. An unusual cause of recurrent pediatric neck abscess: pyriform sinus fistula[J]. Clin Imaging, 2007, 31(5):349-351. doi:10.1016/j.clinimag.2007.03.001.
[5] Yolmo D, Madana J, Kalaiarasi R, et al. Retrospective case review of pyriform sinus fistulae of third branchial arch origin commonly presenting as acute suppurative thyroiditis in children[J]. J Laryngol Otol, 2012, 126(7):737-742. doi:10.1017/S0022215112000898.
[6] Wong PY, Moore A, Daya H. Management of third branchial pouch anomalies - an evolution of a minimally invasive technique[J]. Int J Pediatr Otorhinolaryngol, 2014, 78(3):493-498. doi:10.1016/j.ijporl.2013.12.027.
[7] Nicoucar K, Giger R, Jaecklin T, et al. Management of congenital third branchial arch anomalies: a systematic review[J]. Otolaryngol Head Neck Surg, 2010, 142(1):21-28. doi:10.1016/j.jpedsurg.2008.12.001.
[8] Nicoucar K, Giger R, Pope HJ, 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.
[9] Pearce EN, Farwell AP, Braverman LE. Thyroiditis[J]. N Engl J Med, 2003, 348(26):2646-2655.
[10] Masuoka H, Miyauchi A, Tomoda C, et al. Imaging studies in sixty patients with acute suppurative thyroiditis[J]. Thyroid, 2011, 21(10):1075-1080. doi:10.1089/thy.2010.0366.
[11] Shrime M, Kacker A, Bent J, et al. Fourth branchial complex anomalies: a case series[J]. Int J Pediatr Otorhinolaryngol, 2003, 67(11):1227-1233. doi:10.1016/j.ijporl.2003.07.015.
[12] 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.
[13] Chauhan NS, Sharma YP, Bhagra T, et al. Branchial fistula arising from pyriform fossa: CT diagnosis of a case and discussion of radiological features[J]. Clin Imaging, 2012, 36(5):591-594. doi:10.1016/j.clinimag.2012.01.032.
[14] 梁璐, 陈良嗣, 周正根, 等. 先天性梨状窝瘘的影像特征[J]. 中华放射学杂志, 2016, 50(3):196-200. doi:10.3760/cma.j.issn.1005-1201.2016.03.008. LIANG Lu, CHEN Liangsi, ZHOU Zhenggen, et al. Comparative imaging studies of congenital pyriform sinus fistula[J]. Chin J Radiol, 2016, 50(3):196-200. doi:10.3760/cma.j.issn.1005-1201.2016.03.008.
[15] 李守震, 吴晓丽, 王军, 等. 梨状窝瘘及其所致甲状腺脓肿的超声诊断[J]. 中华超声影像学杂志, 2016, 25(10):917-919. doi:10.3760/cma.j.issn.1004-4477.2016.10.026. LI Shouzhen, WU Xiaoli, WANG Jun, et al. The ultrasonic diagnosis of piriform sinus fistula and the thyroid abscess caused by it[J]. Chin J Ultrasonogr, 2016, 25(10):917-919. doi:10.3760/cma.j.issn.1004-4477.2016.10.026.
[16] Miyauchi A, Tomoda C, Uruno T, et al. Computed tomography scan under a trumpet maneuver to demonstrate piriform sinus fistulae in patients with acute suppurative thyroiditis[J]. Thyroid, 2005, 15(12):1409-1413. doi:10.1089/thy.2005.15.1409.
[17] Zhang P, Tian X. Recurrent neck lesions secondary to pyriform sinus fistula[J]. Eur Arch Otorhinolaryngol, 2016, 273(3):735-739. doi:10.1007/s00405-015-3572-2.
[18] Stone M E, Link D T, Egelhoff J C, et al. A new role for computed tomography in the diagnosis and treatment of pyriform sinus fistula[J]. Am J Otolaryngol, 2000, 21(5):323-325. doi:10.1053/ajot.2000.16169.
[19] 吴伟军, 韩燕乔, 龚振华. 食管吞钡造影及造影后CT平扫在诊断梨状窝瘘中的价值探讨[J].华西医学, 2009, 24(12):3104-3105. WU Weijun, HAN Yanqiao, GONG Zhenhua. On the Value of Esphagogram and CT Scan after Esphagogram in Diagnostic of Pyriform Sinus Fistula[J]. West China Medical Journal, 2009, 24(12):3104-3105.
[20] 黄舒玲, 粱璐. 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. Progress in surgery treatment of congenital pyriform sinus fistula[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2016, 30(18):1491-1494. doi:10.13201/j.issn.1001-1781.2016.18.017.
[21] Huang YC, Peng SS, Hsu WC. KTP laser assisted endoscopic tissue fibrin glue biocauterization for congenital pyriform sinus fistula in children[J]. Int J Pediatr Otorhinolaryngol, 2016, 85:115-119. doi:10.1016/j.ijporl.2016.03.028.
[22] Sheng Q, Lv Z, Xu W, et al. Differences in the diagnosis and management of pyriform sinus fistula between newborns and children[J]. Reports, 2019, 9(1):18497. doi:10.1038/s41598-019-55050-9.
[23] Haitao Z, Xianmin X, Shan Z, et al. Diagnosis and management of pyriform sinus cyst in neonates: 16-year experience at a single center[J]. Journal of Pediatric Surgery, 2017, 52(12):1989-1993. doi:10.1016/j.jpedsurg.2017.08.041.
[24] 潘静, 钟微, 杨纪亮, 等.新生儿梨状窝瘘37例 [J].中华新生儿科杂志,2020,35(5): 368-370. doi: 10.3760/cma.j.issn.2096-2932.2020.05.011. PAN Jin, ZHONG Wei, YANG Jiliang, et al. 37 cases of neonatal piriform sinus fistula[J]. Chinese Journal of Neonatology, 2020,35(5): 368-370. doi: 10.3760/cma.j.issn.2096-2932.2020.05.011.
[25] 尹记辉,沈淳,郑珊 等.新生儿梨状窝瘘的诊治特点[J].中华新生儿科杂志,2010, 31(11):805-808. doi:10.3760/cma.j.issn.0253-3006.2010.11.001. YIN Jihui, SHEN Chun, ZHENG Shan, et al. Diagnosis and treatment of pyriform sinus fistula in neonates[J]. Chinese Journal of Neonatology, 2010, 31(11):805-808. doi:10.3760/cma.j.issn.0253-3006.2010.11.001.
[26] Cha W, Cho SW, Hah JH, et al. Chemocauterization of the internal opening with trichloroacetic acid as first-line treatment for pyriform sinus fistula[J]. Head Neck, 2013, 35(3):431-435. doi:10.1002/hed.22998.
[27] Park JH, Jung YH, Sung MW, et al. Temporary vocal fold immobility after chemocauterization of the pyriform sinus fistula opening with trichloroacetic acid[J]. Laryngoscope, 2013, 123(2):410-413. doi:10.1002/lary.23530.
[28] Wang S, He Y, Zhang Y, 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.
[29] Leboulanger N, Ruellan K, Nevoux J, et al. Neonatal vs delayed-onset fourth branchial pouch anomalies: therapeutic implications[J]. Arch Otolaryngol Head Neck Surg, 2010, 136(9):885-890. doi:10.1001/archoto.2010.148.
[30] Di Nardo G, Valentini V, Angeletti D, et al. Recurrent pyriform sinus fistula successfully treated by endoscopic Glubran 2 sealing: A rare case and literature review[J]. SAGE Open Med Case Rep, 2016,4:2050313X-16672151X. doi:10.1177/2050313X16672151.
[31] Kamide D, Tomifuji M, Maeda M, et al. Minimally invasive surgery for pyriform sinus fistula by transoral videolaryngoscopic surgery[J]. Am J Otolaryngol, 2015, 36(4):601-605. doi:10.1016/j.amjoto.2015.02.009.
[32] Matsuzaki H, Makiyama K, Suzuki H, et al. Prevention of neck infection by endoscopic suture closure of pyriform sinus fistulae: a report of two cases[J]. Braz J Otorhinolaryngol, 2018, 84(2):257-259. doi:10.1016/j.bjorl.2015.11.012.
[33] Motta G, Esposito E, Testa D, et al. CO2 laser treatment of supraglottic cancer[J]. Head Neck, 2004, 26(5):442-446. doi:10.1002/hed.10395.
[34] 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.
[35] Pereira KD, Smith SL. Endoscopic chemical cautery of piriform sinus tracts: a safe new technique[J]. Int J Pediatr Otorhinolaryngol, 2008, 72(2):185-188. doi:10.1016/j.ijporl.2007.10.007.
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