先天性梨状窝瘘的手术治疗和临床解剖学探讨

付营慧; 闵翔; 龙平; 朱恒涛

doi:10.13201/j.issn.1001-1781.2018.13.006

先天性梨状窝瘘的手术治疗和临床解剖学探讨

- 南昌大学第一附属医院耳鼻咽喉头颈外科(南昌, 330006)

详细信息

通讯作者: 闵翔,E-mail:doctorminxiang@163.com

中图分类号: R762

收稿日期: 2018-05-14

The anatomic characteristics and surgical treatment of congenital pyriform sinus fistula

- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, 330006, China

More Information

Corresponding author: MIN Xiang, E-mail: doctorminxiang@163.com

Received Date: 14 May 2018

摘要

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。[JP]
- 梨状窝瘘 /
- 外科手术 /
- 喉返神经
Abstract: 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.
- pyriform sinus fistula /
- surgery /
- recurrent laryngeal nerve

HTML全文

参考文献(22)

[1]	张亚民, 曹华, 桑建中, 等.低温等离子微创治疗143例先天性梨状窝瘘炎症期患者临床分析[J].临床耳鼻咽喉头颈外科杂志, 2017, 31(13):1025-1027.
[2]	REA P A, HARTLEY B E, BAILEY C M.Third and fourth branchial pouch anomalies[J].J Laryngol Otol, 2004, 118:19-24.
[3]	LISTON S L.Fourth branchial fistula[J].Otolaryngol Head Neck Surg, 1981, 89:520-524.
[4]	钟贞, 刘玉和, 赵恩民, 等.先天性第四鳃裂畸形的走行探讨和治疗经验[C]//全国耳鼻咽喉头颈外科中青年学术会议论文汇编.2012:592-595.
[5]	MADANA J, YOLMO D, KALAIARASI R, et al.Recurrent neck infection with branchial arch fistula in children[J].Int J Pediatr Otorhinolaryngol, 2011, 75:1181-1185.
[6]	HOUCK J.Excision of branchial cysts[J].Otolaryngol Head Neck Surg, 2005, 16:213-222.
[7]	BAJAJ Y, IFEACHO S, TWEEDIE D, et al.Branchial anomalies in children[J].Int J Pediatr Otorhinolaryngol, 2011, 75:1020-1023.
[8]	LI W, XU H, ZHAO L, et al.Branchial anomalies in children:a report of 105surgical cases[J].Int J Pediatr Otorhinolaryngol, 2018, 104:14-18.
[9]	LEBOULANGER N, RUELLAN K, NEVOUX J, et al.Neonatal vs delayed-onset fourth branchial pouch anomalies:therapeutic implications[J].Arch Otolaryngol Head Neck Surg, 2010, 136:885-890.
[10]	朱霆, 董永红, 谭华章, 等.儿童第四鳃裂畸形的诊断和手术治疗方法[J].临床耳鼻咽喉头颈外科杂志, 2013, 27(12):646-650.
[11]	LU W H, FENG L, SANG J Z, et al.Various presentations of fourth branchial pouch sinus tract during surgery[J].Acta Otolaryngol, 2012, 132:540-545.
[12]	黄舒玲, 梁璐, 陈良嗣.先天性梨状窝瘘的外科治疗进展[J].临床耳鼻咽喉头颈外科杂志, 2016, 30(18):1491-1494.
[13]	李玉晓, 何晓光, 王雨, 等.第三、四鳃裂畸形的临床特征及疗效分析[J].临床耳鼻咽喉头颈外科杂志, 2016, 30(15):1201-1205.
[14]	梁璐, 陈良嗣, 周正根, 等.先天性梨状窝瘘的影像特征[J].中华放射学杂志, 2016, 50(3):196-200.
[15]	NICOUCAR K, GIGER R, JR P H, et al.Management of congenital fourth branchial arch anomalies:a review and analysis of published cases[J].J Pediatr Surg, 2009, 44:1432-1439.
[16]	陈良嗣, 张思毅, 罗小宁, 等.先天性第四鳃裂畸形的诊断和治疗[J].中华耳鼻咽喉头颈外科杂志, 2010, 45(10):835-838.
[17]	JAMES A, STEWART C, WARRICKk P, et al.Branchial sinus of the piriform fossa:reappraisal of third and fourth branchial anomalies[J].Laryngoscope, 2007, 117:1920-1924.
[18]	XIAO X, ZHENG S, ZHENG J, et al.Endoscopic-assisted surgery for pyriform sinus fistula in children:Experience of 165cases from a single institution[J].J Pediatr Surg, 2014, 49:618-621.
[19]	NICOUCAR K, GIGER R, JAECKLIN T, et al.Management of congenital third branchial arch anomalies:a systematic review[J].Otolaryngol Head Neck Surg, 2010, 142:21-28.
[20]	桑建中, 路武豪, 娄卫华.先天性梨状窝瘘管的诊断与治疗[J].中华耳鼻咽喉头颈外科杂志, 2011, 46(9):728-732.
[21]	PICCIONI M, BOTTAZZOLI M, NASSIF N, et al.Intraoperative use of fibrin glue dyed with methylene blue in surgery for branchial cleft anomalies[J].Laryngoscope, 2016, 126:2147-2150.
[22]	WANG L, SANG J, ZHANG Y, et al.Evaluation of endoscopic coblation treatment for obliteration of congenital pyriform sinus fistula[J].Acta Otolaryngol, 2018, 17:1-5.