超声引导穿刺联合内镜下内瘘口黏膜电烧灼术治疗新生儿梨状窝瘘的经验初探  

Preliminary experience of ultrasound-guided puncture combined with endoscopic cauterization in the treatment of neonatal pyriform sinus fistula

作　　者：张洋 毕静[1] 余波 付勇[1] ZHANG Yang;BI Jing;YU Bo;FU Yong(Department of Otolaryngology Head and Neck Surgery,the Children's Hospital,Zhejiang University School of Medicine,Hangzhou,310052,China)

机构地区：[1]浙江大学医学院附属儿童医院耳鼻咽喉头颈外科,杭州310052

出　　处：《临床耳鼻咽喉头颈外科杂志》2025年第2期152-157,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨新生儿梨状窝瘘的诊断及微创治疗方法。方法:回顾性分析2016年1月—2023年12月浙江大学医学院附属儿童医院确诊为新生儿梨状窝瘘患儿的临床资料,包括诊断过程与治疗方法。结果:共有8例患儿,其中男2例,女6例;左侧7例,右侧1例。6例产前检查发现胎儿颈部包块,2例出生后发现颈部肿物。8例患儿均有不同程度的呼吸障碍。入院后所有患儿均行颈部超声及增强CT检查。颈部超声均提示颈部囊性肿物,其中囊肿伴有分隔者3例;增强CT检查中,发现颈部囊肿有气液平者6例。所有患儿均采用超声引导下颈部肿物穿刺和(或)置管,并在支撑喉镜下行梨状窝内瘘口黏膜电烧灼术,术中发现囊液均为黄色稀薄样液体,无感染表现,手术操作顺利。术后随访12~72个月,未见声嘶等并发症,亦无复发病例。结论:新生儿梨状窝瘘多表现为颈部较大的囊性包块合并不同程度的呼吸困难,颈部增强CT见肿块内有气液平可作为梨状窝瘘早期诊断的重要依据,超声引导穿刺联合内镜下内瘘口黏膜电烧灼术疗效好、创伤小、安全性高,可作为新生儿梨状窝瘘的一种微创治疗方式。Objective To explore the diagnosis and minimal invasive treatment of neonatal pyriform sinus fistula.Methods A retrospective analysis was conducted on the clinical data of newborns diagnosed with pyriform sinus fistula in the Children's Hospital,Zhejiang University School of Medicine from January 2016 to December 2023,including the diagnostic process and treatment methods.Results There were 8 children,2 males and 6 females,with 7 cases on the left side and 1 case on the right side.Six cases revealed a lump in the fetal neck during prenatal examination,and two cases were found to have a neck mass after birth.All cases presented with varying degrees of respiratory disorders.After admission,all patients underwent neck ultrasound and contrast-enhanced CT examination.Neck ultrasound showed cystic masses,with 3 of the cysts accompanied by septa,and an air-fluid level was observed in the cysts in 6 cases from contrast-enhanced CT.All patients underwent ultrasound-guided neck mass puncture and/or tube placement combined with endoscopic electrocauterization.The cystic fluid was found to be yellow and thin,with no signs of infection.The surgical operations were uneventful,and the follow-up time ranged from 12 to 72 months postoperatively.There were no complications such as hoarseness,and no recurrence cases were reported.Conclusion Neonatal pyriform sinus fistula is often characterized by a large cystic mass in the neck combined with respiratory depression.The presence of an air-fluid level in the cyst from contrast-enhanced CT can be considered an important basis for early diagnosis of pyriform sinus fistula.Ultrasound-guided puncture combined with endoscopic electrocauterization is minimally invasive and safe,making it a suitable minimal invasive treatment for neonatal pyriform sinus fistula.

关 键 词：新生儿 梨状窝瘘 内镜下内瘘口黏膜电烧灼术 

分 类 号：R726.53[医药卫生—儿科]