支撑喉镜下梨状隐窝瘘内瘘口化学烧灼加缝合封闭术的疗效观察  

Observation of curative effect of endoscopic chemocauterization and mucosal suturing closure of the internal opening for treatment of pyriform sinus fistula

作　　者：田家军[1] 吕正华[1] 叶犇[1] 徐伟[1] Tian Jiajun Lyu Zhenghua Ye Ben Xu Wei(Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250022, Chin)

机构地区：[1]山东大学附属省立医院耳鼻咽喉科,济南250022

出　　处：《中华解剖与临床杂志》2017年第2期144-147,共4页Chinese Journal of Anatomy and Clinics

摘　　要：目的 探讨支撑喉镜下内瘘口化学烧灼加缝合封闭术治疗梨状隐窝瘘的临床疗效.方法 回顾分析2012年3月-2014年12月山东大学附属省立医院耳鼻咽喉科收治的16例梨状隐窝瘘患者的临床资料.患者均采用支撑喉镜下内瘘口化学烧灼加瘘口黏膜缝合封闭术,脓肿形成者同期给予颈部切开引流.男9例、女7例,年龄6~54岁;左侧13例、右侧2例、双侧1例.表现为反复发作的化脓性甲状腺炎9例、反复发作的颈部脓肿5例,其中颈部和/或甲状腺区脓肿形成者11例;另2例为外院结节性甲状腺肿术后咽瘘形成.结果 所有患者术后2周复查电子喉镜,梨状隐窝内瘘口处瘢痕形成,内瘘口均愈合良好;颈部脓肿切开后,经换药引流均于2周内愈合;随访13~41个月,复查电子喉镜均未见梨状隐窝瘘口残留.1例患者于术后第4周出现轻度甲状腺炎,经抗炎治疗后炎症消退,余均无复发.16例患者均未发生吞咽困难、咽部剧烈疼痛等并发症.结论 支撑喉镜下内瘘口化学烧灼加黏膜缝合封闭术能够有效地治愈梨状隐窝瘘,颈部脓肿形成的患者应同期给予脓肿切开引流.Objective To evaluate the effectiveness of endoscopic cauterization and mucosal suturing surgical management in the treatment of pyriform sinus fistula.Methods From March 2012 to December 2014, 16 patients were performed endoscopic closure of pyriform sinus fistula by mucosal suturing.All patients were treated with endoscopic cauterization and mucosal suturing.Patients presenting with acute neck abscess were processed simultaneously with surgical management of incision and drainage.There were 9 males and 7 females.The ages ranged from 6 to 54 years old.The lesions were predominantly left sided （13/16）, and generally presented as acute suppurative thyroiditis （9/16） or recurrent neck abscess （5/16）, two patients presented with pharyngocutaneous fistula following ipsilateral thyroidectomy.Among them, 11 patients showed acute neck infections or pharyngocutaneous fistula at the time of hospitalization.Results Two weeks post-operation, telescopic hypopharyngoscopy was employed to confirm the closure of the internal opening in all patients, and they all presented with the formation of scar tissue at piriform fossa.Following external incision and drainage, all cases presenting with acute neck abscess recovered within two weeks.Except one case presented with slight thyroiditis and rapidly recovered after antibiotic treatment, there were no serious complications and no recurrence within the follow-up period ranging from 13 to 41 months.Conclusions Endoscopic mucosal suturing closure of the internal opening is a safe and effective treatment for pyriform sinus fistula patients.Patients presenting with acute neck abscess should be processed simultaneously with incision and drainage.

关 键 词：瘘 梨状隐窝 喉镜外科手术 化学烧灼 缝合 

分 类 号：R762[医药卫生—耳鼻咽喉科]