山东大学耳鼻喉眼学报 ›› 2022, Vol. 36 ›› Issue (1): 125-130.doi: 10.6040/j.issn.1673-3770.0.2021.444

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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

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   

  1. 国家儿童医学中心/儿童耳鼻咽喉头颈外科疾病北京市重点实验室/首都医科大学附属北京儿童医院 耳鼻咽喉头颈外科, 北京 100045
  • 发布日期:2022-02-22
  • 通讯作者: 倪鑫. E-mail:nixin@bch.com.cn

A clinical analysis on children with congenital pyriform sinus fistula treated through microscopic laryngoscopy with CO2 laser cauterization

LONG Ting, LIU Yuwei, WANG Shengcai, ZHANG Jie, LI Yanzhen, ZHANG Xuexi, LIU Qiaoyin, LIU Zhiyong, SUN Nian, NI Xin   

  1. Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing Key Laboratory for Pediatric Diseases of Otorhinolaryngology Head and Neck Surgery, National Center for Children’s Health (NCCH), Beijing 100045, China
  • Published:2022-02-22

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摘要： 目的 了解儿童先天性梨状窝瘘CPSF临床特点,为规范化儿童CPSF的诊断及微创治疗方案提供依据。 方法 回顾性分析2014~2021年确诊的CPSF患儿,所有患儿予单纯内镜下CO2激光烧灼术的标准治疗方案,经过一次或多次手术治疗达到治疗终点。 结果 研究共纳入273例(6.28±3.33岁)患儿。术前行超声检查阳性率91.2%(197/216)、增强MRI检查阳性率82.8%(101/122)。内瘘口行CO2激光烧灼术治疗方案,173例(63.0%)患儿经过一次手术,61例(22.3%)患儿经过2次手术达到治疗终点,在显微镜下见内瘘口完全消失。统计分析患儿既往颈部开放手术史,并不影响手术次数,而初次激光手术年龄为手术的独立危险因素。所有患儿均未出现严重并发症。 结论 单纯内镜下CO2激光烧灼术治疗儿童CPSF安全有效。该诊治方案具有微创、可重复性、适用年龄广、临床依从性好等特点,为儿童CPSF规范化诊治提供依据。

关键词: 先天性梨状窝瘘, 儿童, CO2激光, 显微支撑喉镜

Abstract: Objective The objective of this study is to explore the clinical characteristics of children with congenital pyriform sinus fistula(CPSF). It also aims to standardize its diagnosis and serve as a reference for the treatment of children with CPSF through microscopic laryngoscopy with CO2 laser cauterization. Methods A retrospective, single-center study was conducted by analyzing the clinical data of children diagnosed with CPSF in Beijing Children's Hospital(BCH)from 2014 to 2021. Microscopic laryngoscopy involving CO2 single-laser cauterization was performed on children with CPSF until the internal fistula completely closed after one or two procedures. Results A total of 273 patients(6.28±3.33 years)were enrolled in this study. Preoperative examination showed a positive predictive value(PPV)of 91.2% when ultrasonography was used, and 82.8% when enhanced magnetic resonance imaging(MRI)was used. All patients were treated with a standardized procedure of CO2 laser cauterization in our center, with 173(63.0%)of the patients undergoing only one operation and 61(22.3%)of the patients undergoing two procedures until the internal fistulas completely closed. Multivariate logistic regression analysis showed that a history of open neck surgery was not related to the number of times the procedure was done. In contrast, the age at the first CO2 laser cauterization surgery was an independent risk factor for the number of procedures needed for the internal fistula to close. All patients did not suffer severe postoperative complications. Conclusion Our study revealed that CO2 laser cauterization is a therapeutic strategy that is effective, safe, and has repeatable results. This method can be the preferred treatment for pediatric CPSF.

Key words: Congenital pyriform sinus fistula, Pediatrics, Carbon dioxide laser, Microscopic laryngoscope

中图分类号: 

  • R762
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