婴幼儿颈深部病变压迫引起上气道梗阻的临床研究及误诊分析  

The clinical characteristics of the upper airway obstruction induced by cervical lesions in infants

作　　者：冯爽 秦昊 孙昌志 陈彦球 罗仁忠 FENG Shuang;QIN Hao;SUN Changzhi;CHEN Yanqiu;LUO Renzhong(Department of Otolaryngology,Guangzhou Women and Children's Medical Center,Guangzhou,Guangdong,510120,China)

机构地区：[1]广州市妇女儿童医疗中心耳鼻咽喉科,广东广州510120

出　　处：《中国耳鼻咽喉头颈外科》2021年第8期510-513,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨以上气道梗阻为主要症状的婴幼儿颈深部病变的临床特点及误诊分析。方法收集2016年1月~2019年12月首诊误诊为上气道感染,最后经过影像学检查确诊为颈深部病变导致上气道梗阻而转入广州市妇女儿童医疗中心耳鼻咽喉科行手术治疗的婴幼儿患者,分析其诊疗经过及误诊原因,总结其临床特点。结果共收集患儿资料13例,平均年龄为11个月。7例患儿首发症状为发热,6例为呼吸不畅,6例体格检查发现颈部及下颌部肿物。13例患儿首诊时均诊断为上气道感染,给予抗炎治疗无效,并进展为呼吸困难,行颈部影像学检查确诊为颈深部病变压迫上气道,转入我科手术治疗。最终确诊为咽旁、咽后脓肿8例,咽旁、咽后间隙神经母细胞瘤1例,鳃裂囊肿2例,梨状窝瘘伴感染1例,咽旁、咽后间隙淋巴管瘤1例。术后随访6个月~2年,除1例淋巴管瘤患儿复发再次出现呼吸困难,其余未见复发。结论婴幼儿颈深部病变可导致上气道梗阻,其早期表现缺乏特征性容易误诊和漏诊,临床医师应该加强对此类疾病的认识。颈部CT及MRI对诊断有重要的指导意义,手术治疗是解除上气道压迫的首选方法。OBJECTIVE To investigate the clinical characteristics of cervical lesions in infants with the upper airway obstruction as the main symptom.METHODS The clinical data of infants,who were suffered from the upper airway obstruction by cervical lesions,were collected from January 2016 to December 2019.They were confirmed through the neck imaging examination,and transferred to our department for surgery.The clinical characteristics of these patients were analyzed.RESULTS Thirteen cases were included in this study,with an average age of 11 months.Before came to our department,fever and cough were presented in 7 cases,and neck masses were found in 6 cases.All of them was considered as airway infection at first,and treated with anti-inflammatory drugs for a long period.After that,inspiratory dyspnea was become as the main symptoms before the surgery.The upper airway was compressed by the cervical lesions,which was confirmed by cervical imaging examination,CT/MRI.After surgery,it is confirmed that 8 cases of parapharyngeal and retropharyngeal abscess,1 case of neuroblastoma,2 cases of branchial cyst,1 case of pyriform pit fistula with infection,1 case of lymphangioma in parapharyngeal and retropharyngeal space.After 0.5-2 years follow-up,except for 1 case of recurrent lymphangioma,the other patients had no recurrence.CONCLUSION The upper airway obstruction is one of the symptoms induced by the cervical lesions in infants.It is easy to be misdiagnosed if the physician lack of the knowledge of these diseases.Therefore,we should pay more attention to its clinical characteristics.CT or MRI examination is helpful for the diagnosis.Surgical treatment is the first choice to relieve the upper airway compression induced by the cervical lesions in infants.

关 键 词：呼吸困难 误诊 感染 婴幼儿 颈深部病变 

分 类 号：R725.6[医药卫生—儿科]