经口内镜下低温等离子微创治疗儿童先天性梨状窝瘘  

Mini-invasive treatment of transoral endoscopic coblation for congenital pyriform sinus fistula in children

作　　者：僧东杰 益欢欢 张红[1] 徐艳霞 朱卿文 崔艳红[1] 张杰[2] Seng Dongjie;Yi Huanhuan;Zhang Hong;Xu Yanxia;Zhu Qingwen;Cui Yanhong;Zhang Jie(Department of Otolaryngology,Head and Neck Surgery,Affiliated Children's Hospital,Zhengzhou University,Henan Children's Hospital,Zhengzhou 450018,China;Department of Otorhinolaryngology,Head and Neck Surgery,Beijing Children's Hospital,Capital Medical University&National Center for Children's Health,Beijing 100045,China)

机构地区：[1]河南省儿童医院耳鼻咽喉头颈外科,郑州大学附属儿童医院,郑州450018 [2]首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,北京100045

出　　处：《中华小儿外科杂志》2022年第2期112-116,共5页Chinese Journal of Pediatric Surgery

基　　金：河南省医学科技攻关计划(LHGJ201702325)。

摘　　要：目的探讨经口内镜下低温等离子封闭内瘘口治疗儿童梨状窝瘘的手术方法及预后。方法收集2018年1月至2020年4月河南省儿童医院收治的31例先天性梨状窝瘘患儿的临床资料。其中,男17例,女14例,年龄范围为21 d至9岁,中位年龄为3岁2个月。31例患儿均为左侧发病,16例患儿有脓肿切开引流史。术前CT检查显示脓肿内有含气腔和/或梨状窝内发现内瘘口即可确诊。全身麻醉支撑喉镜辅助下充分暴露梨状窝、经口用鼻内镜寻找内瘘口。术者左手持硬质内镜,右手用低温等离子电凝档位灼烧封闭内瘘口。结果31例患儿均顺利实施低温等离子封闭内瘘口。术后留置胃管、鼻饲5~9 d,拔除胃管前复查电子喉镜,内瘘口完全封闭、黏膜光滑平整。术后随访4~28个月,患儿一般情况良好,无并发症、未见复发病例。结论经口内镜下低温等离子封堵内瘘口治疗儿童梨状窝瘘,数分钟内即可完成手术,可成为治疗梨状窝瘘的首选方法。Objective To explore the surgical approaches and prognosis of children with congenital left pyriform sinus fistula after closure of transoral endoscopic coblation.Methods From January 2018 to April 2020,clinical data were retrospectively reviewed for 31 hospitalized children of congenital left piriform fossa fistula at Henan Children's Hospital.There were 17 boys and 14 girls with a median age of 38 months(21 days to 108 months).Sixteen cases had a previous history of abscess incision and drainage.Preoperative examination of computed tomography(CT)revealed air cavity in abscess and/or internal fistula in piriform fossa.Under general anesthesia and laryngoscope,piriform fossa was thoroughly exposed and internal fistula located by nasal endoscopy through mouth.Rigid endoscope was held in left hand and closed internal fistula with low-temperature plasma electrocoagulation in right hand.Results Internal fistula was successfully sealed by low-temperature plasma.Postoperative gastric tube was inserted for nasogastric feeding for 5 to 9 days.Electronic laryngoscopy was performed before removing gastric tube.Internal fistula was completely closed with an even and smooth mucosa.During a follow-up period of 4 to 28 months,there were no complications or recurrence.Conclusion Piriform fossa fistula in children may be managed within a few minutes after operation by low-temperature plasma sealing under oral endoscopy.It is a preferred treatment of piriform fossa fistula.

关 键 词：先天畸形 鳃裂瘘管 内镜 儿童 微创手术 

分 类 号：R762[医药卫生—耳鼻咽喉科]