梨状窝穿孔的诊断和治疗  

Diagnosis and treatment of pyriform sinus perforation

作　　者：程庆[1] 刘邦华[1] 汪吉宝[1] 

机构地区：[1]华中科技大学附属协和医院耳鼻咽喉头颈外科,武汉430022

出　　处：《中华耳鼻咽喉头颈外科杂志》2013年第2期139-142,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨梨状窝穿孔的诊断和治疗方法。方法15例梨状窝穿孔患者大部分伴有咽部疼痛或发热，均行x线食管碘油造影和CT检查明确诊断。其中9例采取禁食，静脉应用广谱抗生素和营养支持等保守治疗；6例采取瘘口修补或颈部引流等手术治疗。结果15梨状窝穿孔患者中，症状较轻且未发生严重并发症的9例采取保守治疗2周后治愈。6例有严重并发症的患者中3例采用颈部或上纵隔引流，3例采用瘘口修补术。所有患者均于治疗后2—4周行X线食管碘油造影检查，穿孔均愈合，随访1～30个月，无再发梨状窝穿孔。结论病程不超过12h或症状较轻无明显并发症的梨状窝穿孔应采取保守治疗，对症状重、穿孑L大且有严重并发症者应积极手术治疗。梨状窝穿孔的早期诊断和积极有效的治疗，可促进穿孔的愈合，减少并发症。Objective To investigate the early diagnosis, treatment and prognosis of pyriform sinus perforation. Methods Fifteen patients were diagnosed to have pyriform sinus perforation, most of them were associated with pharyngeal pain or fever. Contrast X-ray and CT scan were used to confirm the perforation. Results Conservative treatment was used in 9 cases with wild symptoms and surgical intervention in 6 cases with severe symptoms and complications. Both methods achieved better clinical efficacy. By relevant examination, the perforation healed within 2 - 4 weeks and none had re-perforation for 1 - 30 months follow- up. Conclusions Pyriform sinus perforation with wild symptoms and within 12 hours can be treated conservatively. Large perforation （ 〉 2 cm） last more than 12 hours or with any complications require exploration, surgical repair if possible and adequate drainage. Early diagnosis and effective treatment can reduce the incidence of complications and improve the survival rate of patients.

关 键 词：下咽 创伤和损伤 诊断 治疗 

分 类 号：R762[医药卫生—耳鼻咽喉科]