先天性梨状窝瘘的手术治疗和临床解剖学探讨  

The anatomic characteristics and surgical treatment of congenital pyriform sinus fistula

作　　者：付营慧 闵翔[1] 龙平[1] 朱恒涛[1] FU Yinghui;MIN Xiang;LONG Ping;ZHU Hengtao(Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Nan- chang University, Nanchang, 330006, Chin)

机构地区：[1]南昌大学第一附属医院耳鼻咽喉头颈外科,南昌330006

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第13期984-987,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:对先天性梨状窝瘘的临床解剖学特点进行探讨,总结手术治疗经验。方法:回顾性分析12例先天性梨状窝瘘患者的临床资料。结果:术中探查全部病变均位于喉上神经外下方,瘘管与甲状腺上极关系密切,在经过甲状腺上极后于喉返神经入喉段外侧进入梨状窝或食管入口;术后随访8~65个月,其中1例患者于术后2个月再次出现侧颈部脓肿,行颈部切开引流、抗感染治疗后痊愈,随访至今(3年)无复发。结论:临床发现先天性梨状窝瘘与甲状腺上极和喉返神经关系密切,其实际走行与理论存在差异;术中未发现行于上纵隔或胸腔的类型,也未见瘘管沿颈鞘向上走行;所有瘘管均经喉返神经入喉段外侧进入梨状窝或食管入口处,手术切除受累甲状腺上极并显露喉返神经至入喉处是完整切除的关键;对于反复感染、结构不清晰者不必行大范围的颈清手术方式。Objective：To discuss the clinical anatomic characteristics of congenital pyriform sinus fistula and summarize the experiences of open neck surgery.Method：The clinical data of 12 patients with congenital pyriform sinus fistula were retrospectively analyzed.Result：During the operation,all lesions were located below of superior laryngeal nerve.All fistulas were closely related with the supperior part of thyroid gland and laterally passed over the left recurrent laryngeal nerve just before merging into the apex of piriform sinus or beginning of aesophagus.Follow-up periods were ranging between 8 to 65 months.Two months after surgery,one patient showed lateral neck abscess again.After open drainage procedures and antibiotics treatment,there was no recurrence signs during 3 years of follow-up.Conclusion：We found that the congenital pyriform sinus fistula was closely related to the superior thyroid gland and recurrent laryngeal nerve,which was different from the popular theory.We had not encountered types descending into mediastinum and thoracic cavity or ascending along common carotid artery sheath.All fistulas passed over the left recurrent laryngeal nerve,and then merged into the apex of pyriform sinus or beginning of aesophagus.The key point for successful resection of fistulas in block was to remove the superior involvement part of the thyroid gland and exposure the recurrent laryngeal nerve.Based on our practical findings,the neck dissection procedure shouldn＇t be taken in some patients that the anatomical structure is not clear for repeated infections.

关 键 词：梨状窝瘘 外科手术 喉返神经 

分 类 号：R762[医药卫生—耳鼻咽喉科]