摘要
目的 总结并分析儿童先天性梨状窝瘘误诊的原因,提高对梨状窝瘘的认识.方法 分析2013年1月至2017年1月昆明市儿童医院耳鼻咽喉头颈外科收治的28例先天性梨状窝瘘患儿的临床资料,年龄11个月至14岁,中位年龄5岁,其中20例有外院误诊病史患儿均行颈部超声和增强CT检查,支撑喉镜下明确内瘘口,行瘘管高位结扎.结果 本组患儿误诊比例为20/28,误诊误治时间最短6个月,最长者达3年.支撑喉镜检查均发现梨状窝瘘口,19例位于左侧,1例位于右侧,均为单侧发病.7例误诊为化脓性淋巴结炎,给予反复的颈部穿刺和切开引流;3例误诊为“甲状舌管囊肿”,行囊肿切除术,术后3个月复发,其中1例考虑舌骨中段切除不够,行二次扩大的Sistruck手术;1例患儿误诊为“第二鳃裂瘘”;9例患儿被误诊为甲状腺相关疾病,其中4例误诊为急性化脓性甲状腺炎和亚急性甲状腺炎,5例误诊为甲状腺占位性病变,其中2例行甲状腺左叶部分切除术.20例患儿于全麻下行颈外入路瘘管高位结扎,手术顺利,均经手术和病理证实.术后无声嘶、呛咳和咽瘘等并发症发生,随访12个月至4年,中位随访18个月,未见复发.结论 儿童先天性梨状窝瘘临床上不常见,临床中易被误诊.儿童出现左颈部反复感染和（或）脓肿应高度怀疑梨状窝瘘的可能.支撑喉镜检查可明确诊断,颈外入路瘘管高位结扎可取得良好的治疗效果.
Objective To discuss the misdiagnosis of pyriform sinus fistula and to better understand this kind of illness.Methods The analysis was based on twenty-eight patients with congenital pyriform sinus fistula aged from 11 months to 14 years,with the median age of 5 years,and who were surgically treated from January 2013 to January 2017 in Kunming Children＇s Hospital.Twenty patients were misdiagnosed in other hospital.After the routine examination of neck ultrasound and enhanced CT,internal fistula was found by self-retaining laryngoscope,traced by methylene blue,and excised by high ligation.Results Twenty patients were misdiagnosed.The misdiagnosis time ranged from 6 months to 3 years.Under self-retaining laryngoscope,piriform fossa fistula were found in all patients.Nineteen fistula were found in the left and 1 in the right.The fistula in patients was unilateral.Seven cases were misdiagnosed as suppurative lymphadensitis,undergone abscess incisional drainage many times.Three cases were misdiagnosed as thyroglossal duct cyst and performed excision of thyroglossal duct cyst.One case was treated by extended Sistruck operation again because the doctor considered that excision of middle segment of hyoid bone was not enough and the fistula was not ligated completely.One case was misdiagnosed as second branchial cleft fistula on the right side of the neck.Nine cases were misdiagnosed as hyroid-associated diseases including 2 cases suppurative thyroiditis,2 cases subacute thyroiditis and 5 cases thyroid neoplasms.Among them,2 cases underwent partial thyroidectomy.All the patients were treated with high ligation of fistula under general anesthesia.The operation was smooth,and no hoarseness,bucking and pharyngeal fistula occurred after the operation.Postoperative follow-up time ranged from 12 months to 4 years and the median follow-up was 18 months without recurrence.The diagnosis was confirmed pathologically.Condusious Pyriform sinus fistula in children was uncommon and easily misdiagnosed in clinic.The majority of physici
作者
马静
明澄
娄凡
王美兰
林垦
曾文娟
李正才
刘秀芬
张铁松
Ma Jing;Ming Cheng;Lou Fan;Wang Meilan;Lin Ken;Zeng Wenjuan;Li Zhengcai;Liu Xiufen;Zhang Tiesong(Department of Otorhinolaryngology Head and Neck Surgery, Kunming Children＇s Hospita;Head and Neck Disease Treatment Center, Kunming 650228, China)
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2018年第5期381-384,共4页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
云南省高层次卫生技术人才培养项目（D201637）
关键词
先天畸形
梨状窝瘘
误诊
耳鼻喉外科手术
Congenital abnormalities
Pyriform sinus fistula
Diagnostic errors
Otorhinolaryngologic surgical procedures
