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摘要: 目的 分析和总结婴幼儿上气道良性占位的临床特点、诊断、治疗及预后。方法 回顾性分析2012年1月—2022年1月我院诊治的141例上气道良性占位患儿的临床资料。其中男85例，女56例；年龄0~3岁，其中新生儿24例。对其临床特点、辅助检查、治疗结果进行总结和分析。结果 141例患儿主要临床表现为呼吸困难和(或)喉喘鸣，其中先天性舌根囊肿116例，毛息肉15例，鼻咽部第二鳃裂囊肿4例，先天性喉小囊囊肿2例，咽部支气管源性囊肿2例，鼻咽部畸胎瘤1例，肌纤维瘤1例。所有患儿都完成相应检查和治疗，诊断明确，无漏诊或误诊，其中19例舌根囊肿患儿行囊肿穿刺术，术后随访2例先天性舌根囊肿患者，因其术后半年复发故行二次手术，其他患儿预后良好。结论 婴幼儿上气道良性占位，以囊性肿物多见，内镜辅助下低温等离子切除病变为主要治疗方式，对于呼吸困难严重且生命危急的患儿及时的穿刺治疗也是一种安全有效的治疗方法。Abstract: Objective To analyze and summarize the clinical characteristics, diagnosis, treatment and prognosis of benign upper airway space occupancy in infants.Methods The clinical data of 141 cases with begin upper airway space from January 2012 to January 2022 were analyzed. Among them, 101 were male and 68 were female, the age is 0-3 years old. In which there were 24 newborns. The clinical characteristics, auxiliary examination and treatment results were summarized and analyzed.Results The main clinical manifestations of 141 infants were dyspnea and/or laryngeal wheezing, including 116 cases of congenital cyst of tongue, 15 cases of hair polyps, 4 cases of nasopharyngeal second pharyngeal fissure cysts, 2 cases of congenital laryngeal cysts, 2 cases of pharyngeal bronchial cyst, 1 case of nasopharyngeal teratoma and 1 case of myofibroma. All the infants had completed the corresponding examination and treatment. The diagnosis was clear, and there was no missed diagnosis or misdiagnosis. Among them, 19 infants with congenital cyst of tongue were given cyst puncture to relieve dyspnea. 2 cases of congenital cyst of tongue recurred half a year after operaion, and then they underwent reoperation. The prognosis of the remaining infants were good.Conclusion The most common occupying of benign upper airway space occupancy is cyst, and low-temperature plasma resection under endoscope is the main treatment method. Timely puncture therapy is also a safe and effective treatment for infants who are dyspnea and life threatening.
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Key words:
- upper airway mass /
- dyspnea /
- infants /
- low-temperature plasma
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图 1 舌甲状舌管囊肿 舌根部正中囊肿；图2 先天性黏液潴留囊肿 2a：舌根囊肿体积大，堵塞气道严重；2b：囊肿穿刺后残留囊壁位于舌根偏左侧；图3 毛息肉 源于右侧圆枕附近鼻咽部肿物；图4 畸胎瘤鼻咽部体积巨大肿物；图5 鼻咽部第二鳃裂囊肿 左侧鼻咽部扁桃体后方囊肿；图6 先天性喉小囊囊肿 6a：左侧杓会厌皱襞隆起肿物(喉侧型)；6b：左侧喉室区肿物(喉前型)；图7 支气管源性囊肿 右侧扁桃体后上方肿物；图8 炎性肌纤维瘤来源于右侧喉咽部的球形肿物；图9 舌根囊肿；图10 毛息肉；图11 畸胎瘤；图12 鼻咽部第二鳃裂囊肿；图13 喉小囊囊肿；图14 支气管源性囊肿；图15 喉咽部肌纤维瘤
表 1 141例患儿上气道占位临床资料
疾病类型 例数 性别/例 年龄(中位数) 主要症状 部位 鼻咽喉镜 B超 CT或MRI 男 女 先天性舌根囊肿 116 77 39 1 d~3岁(58 d) 喉喘鸣，少数呼吸困难 舌根部 舌根部半圆形隆起肿物，表面多数伴有血管走行(图 1、2) 舌根部边界清楚囊肿 舌根部类圆形低密度影(图 9) 毛息肉 15 5 10 1 d~3岁(1.5 m) 呼吸困难 软腭背侧4例，软腭与鼻咽侧壁交界处4例，硬腭1例，圆枕3例，鼻前庭2例，食道入口1例 灰白色或红色肿物，部分表面可见毛发样结构(图 3) 由脂肪及纤维组织成分为主的边界清楚的实性肿物(图 10) 畸胎瘤 1 0 1 20 h 呼吸困难 右侧咽鼓管附近 鼻咽-口咽部表面光滑肿物(图 4) 鼻咽-口咽腔团状软组织影，边界不清，其内可见多发片状低密度区，并可见点状高密度影(图 11) 鼻咽部第二鳃裂囊肿 4 2 2 出生~3岁 检查发现，打鼾 鼻咽侧壁，左侧2例，右侧2例 鼻咽部隆起光滑肿物(图 5) 鼻咽部边界清楚囊性肿物 边界清楚，密度均一囊性肿物(图 12) 喉小囊囊肿 2 1 1 3 d，6个月 呼吸困难，声音嘶哑 左侧喉部 喉室区，杓会厌皱襞区突起光滑肿物(图 6) 边界清楚囊性肿物 MRI显示囊状长T1、长T2液体信号影，其内信号较均匀，边界较清(图 13) 支气管源性囊肿 2 0 2 1.5岁，3岁 打鼾，体检发现 右侧鼻咽侧壁，右侧扁桃体后上方 表面光滑隆起肿物(图 7) 边界清楚囊性肿物 右侧咽旁可见一团块状软组织密度影，密度均匀(图 14) 喉咽部肌纤维瘤 1 0 1 3岁 打鼾 喉咽部肿物球形肿物，表面可见走行细小血管(图 8) 下咽部实性低回声包块，边界清 喉部团块状软组织影，增强扫面病变不均匀强化，周围可见多发小血管影(图 15) 
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[1] Weldon BC, Krafcik JM. Breath-holding-like spells in an infant: an unusual presentation of lingual thyroglossal duct cyst[J]. J Pediatr Surg, 2000, 35(9): 1381-1384. doi: 10.1053/jpsu.2000.9345
[2] Mondin V, Ferlito A, Muzzi E, et al, Thyroglossal duct cyst: personal experience and literature review[J]. Auris Nasus Larynx, 2008, 35(1): 11-25. doi: 10.1016/j.anl.2007.06.001
[3] 郑燕青, 林少蓉, 林海鹏, 等. 显微支撑喉镜下低温等离子射频消融术治疗新生儿舌根囊肿疗效观察[J]. 中国耳鼻咽喉颅底外科杂志, 2017, 23(6): 577-579. https://www.cnki.com.cn/Article/CJFDTOTAL-ZEBY201706022.htm
[4] 赵利敏, 倪坤, 吴佳丽, 等. 低温等离子射频消融术在婴幼儿舌根囊肿的应用[J]. 中国眼耳鼻喉科杂志, 2015, 15(2): 112-114, 118.
[5] Sameer KS, Mohanty S, Correa MM, et al. Lingual thyroglossal duct cysts--a review[J]. Int J Pediatr Otorhinolaryngol, 2012, 76(2): 165-168. doi: 10.1016/j.ijporl.2011.11.025
[6] 陈超. 婴幼儿喉气道结构异常评估的专家共识[J]. 临床耳鼻咽喉头颈外科杂志, 2023, 37(6): 403-408. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2023.06.001
[7] 窦倩雯, 田秀芬. 舌根部甲状舌管囊肿的诊断与治疗经验[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(7): 683-686. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWFE201101026.htm
[8] 王桂香, 张杰, 赵靖, 等. 婴幼儿舌根囊肿的诊断及围手术期治疗要点[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 62-64. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYU201503018.htm
[9] 程波, 张志茂, 裴智, 等. 低温等离子射频消融系统在舌根囊肿切除术中的应用效果评价[J]. 临床耳鼻咽喉头颈外科杂志, 2015, 29(6): 561-563. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.1001-1781.2015.06.022
[10] 滕以书, 冼志雄, 韩赛红, 等. 婴幼儿咽部毛状息肉五例[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(7): 534-535. doi: 10.3760/cma.j.issn.1673-0860.2017.07.011
[11] Kiroglu AF, Kutluhan A, Bayram I, et al. Reconstruction of a congenital midpalatal hairy polyp[J]. Br J Oral Maxillofac Surg, 2004, 42(1): 72-74. doi: 10.1016/S0266-4356(03)00194-3
[12] Burns BV, Axon PR, Pahade A. 'Hairy polyp' of the pharynx in association with an ipsilateral branchial sinus: evidence that the 'hairy polyp' is a second branchial arch malformation[J]. J Laryngol Otol, 2001, 115(2): 145-148. doi: 10.1258/0022215011907569
[13] 黄爱萍, 张海中, 崔莉, 等. 婴儿毛息肉13例临床特征及诊治分析[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(9): 850-854.
[14] Cay A, Bektas D, Imamoglu M, et al. Oral teratoma: a case report and literature review[J]. Pediatr Surg Int, 2004, 20(4): 304-308.
[15] Chen YA, Su JL, Hao SP. Nasopharyngeal branchial cleft cyst[J]. Otolaryngol Head Neck Surg, 2007, 136(1): 144-146. doi: 10.1016/j.otohns.2005.11.011
[16] Verma A, Sohail MA, al-Khabori M, et al. Nasopharyngeal cyst of branchiogenic origin: report of a case and review of the literature[J]. Ear Nose Throat J, 2000, 79(9): 722-724, 726, 730-731. doi: 10.1177/014556130007900913
[17] Proctor B. Lateral vestigial cysts and fistulas of the neck[J]. Laryngoscope, 1955, 65(6): 355-401. doi: 10.1288/00005537-195506000-00001
[18] 陈勇超, 贾得声, 王一萍, 等. 以睡眠打鼾为首发症状的第二鳃裂囊肿1例[J]. 中华耳鼻咽喉头颈外科杂志, 2022, 57(1): 51-53.
[19] Gill SJ, Bhanu B. NASOPHARYNGEAL BRANCHIAL CYST CAUSING STRIDOR IN NEONATE: A CASE REPORT[J]. Journal of Evolution of Medical and Dental Sciences, 2014, 3(21): 5820-5824. doi: 10.14260/jemds/2014/2668
[20] Shidara K, Uruma T, Yasuoka Y, et al. Two cases of nasopharyngeal branchial cyst[J]. J Laryngol Otol, 1993, 107(5): 453-455. doi: 10.1017/S0022215100123424
[21] 陆颖鑫, 肖洋, 马丽晶, 等. 先天性喉小囊囊肿的临床特点及手术方式选择[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(20): 1612-1614, 1619. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.1001-1781.2016.20.008
[22] DeSanto LW, Devine KD, Weiland LH. Cysts of the larynx--classification[J]. Laryngoscope, 1970, 80(1): 145-176. doi: 10.1288/00005537-197001000-00013
[23] 潘中静, 邱子隽, 吕丹, 等. 误诊为神经鞘瘤的纵隔支气管囊肿1例[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(11): 872-874. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2022.11.013
[24] 任立志, 孙睿. 左侧下颌骨婴幼儿肌纤维瘤病1例[J]. 华西口腔医学杂志, 2020, 38(5): 594-597. https://www.cnki.com.cn/Article/CJFDTOTAL-HXKQ202005025.htm
[25] Lee JW. Mutations in PDGFRB and NOTCH3 are the first genetic causes identified for autosomal dominant infantile myofibromatosis[J]. Clin Genet, 2013, 84(4): 340-341. doi: 10.1111/cge.12238
[26] Martignetti JA, Tian LF, Li D, et al. Mutations in PDGFRB cause autosomal-dominant infantile myofibromatosis[J]. Am J Hum Genet, 2013, 92(6): 1001-1007. doi: 10.1016/j.ajhg.2013.04.024
[27] 庄霞梅, 金科, 李君伟, 等. 婴幼儿肌纤维瘤(病)影像学及临床表现[J]. 中国医学影像技术, 2022, 38(4): 579-583.
[28] Requena L, Kutzner H, Hügel H, et al. Cutaneous adult myofibroma: a vascular neoplasm[J]. J Cutan Pathol, 1996, 23(5): 445-457. doi: 10.1111/j.1600-0560.1996.tb01434.x
[29] Maby A, Guay B, Thuot F. Infantile myofibromatosis treated by mandibulectomy and staged reconstruction with submental flap and free fibula flap: a case report[J]. J Otolaryngol Head Neck Surg, 2019, 48(1): 14. doi: 10.1186/s40463-019-0333-z
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