显微支撑喉镜下低温等离子微创治疗儿童先天性梨状窝瘘

Minimally invasive treatment of congenital pyriform sinus fistula in children by low temperature plasma under microscopic laryngoscope

摘要:

目的探讨显微支撑喉镜下低温等离子微创治疗儿童急性感染期（AIS）与炎症静止期（IQS）先天性梨状窝瘘（CPSF）的临床疗效。方法回顾性分析2017年12月—2019年12月上海交通大学附属儿童医院收治并行低温等离子微创治疗的51例CPSF患者临床资料，其中AIS 22例，IQS 29例，2组患儿均在气管插管全麻支撑喉镜下行低温等离子射频消融封闭梨状窝内瘘口，而AIS的患儿同期行颈部脓肿切开引流术，留置纱条，术后每日颈部换药。全部患儿术后留置胃管２周,应用抗生素治疗7～10 d。观察其疗效、术后复发率及并发症。结果3例处于IQS的患儿分别于术后第5、6、7天因颈部脓肿形成行切开排脓手术，换药4 d后痊愈。2例AIS的患儿术后出现一过性声嘶，于术后1个月内恢复正常。术后随访2～26个月，1例IQS患儿术后半年复发，2次全麻内镜下低温等离子内瘘口烧灼术，其余50例CPSF内瘘口1次封闭，未发生咽瘘、喉返神经损伤、大出血等并发症，无复发，疗效显著。结论推荐显微支撑喉镜下低温等离子微创根治术作为CPSF的首选疗法，对于IQS的CPSF宜实施单纯内瘘口烧灼术，但术前充分告知家属，术后可能因颈部局部脓肿形成，需要切开引流、换药，对于AIS的CPSF，不必等待炎症控制以后，直接同期行颈部脓肿切开引流术。

关键词:先天性梨状窝瘘|显微支撑喉镜|低温等离子|儿童

Abstract:

ObjectiveTo explore the clinical effect of minimally invasive treatment for congenital pyriform sinus fistula (CPSF) of acute infection stage (AIS) and inflammatory quiescence stage (IQS) in children by low temperature plasma under microscopic laryngoscope.MethodsClinical data of 51 children with CPSF treated by low temperature plasma minimally invasive therapy in our hospital from Dec 2017 to Dec 2019 were analyzed retrospectively. Of them, 22 cases were in the AIS and 29 cases were in the IQS. The fistula was closed by low temperature plasma radiofrequency ablation under general anesthesia and laryngoscope in both groups. For those of the AIS, incision and drainage of neck abscess was performed and followed by retained gauze and daily dressing change. All patients were kept gastric intubation for 2 weeks and treated with antibiotics for 7 to 10 days. The curative effect, recurrence rate and complications of the two groups were observed.ResultsThree patients in the IQS underwent incision and drainage of neck abscess on the 5th, 6th and 7th day after operation, and recovered after 4 days of dressing change. Two children in the AIS had transient postoperative hoarseness and got recovered within one month. The followup period ranged from 2 to 26 months. Fistula recurred in one patient of IQS half a year after operation, and got cured with the second cauterization of internal fistula by low temperature plasma under general anesthesia and laryngeal endoscope. The internal fistula of CPSF was closed once in the other 50 cases. In all the 51 cases, no complications such as pharyngeal fistula, recurrent laryngeal nerve injury and massive hemorrhage occurred.ConclusionsLow temperature plasma minimally invasive surgery under microscopic laryngoscope is recommended as the preferred therapy for CPSF. For CPSF in the IQS, only internal fistula cauterization is needed with adequate preoperative information about the risk of neck abscess followed with incision and drainage of abscess as well as daily dressing change. For the treatment of CPSF in the AIS, fistula closure should be performed with simultaneous incision and drainage of neck abscess rather than the control of the acute inflammation.

Key words:Congenital pyriform sinus fistula|Microscopic laryngoscope| Low temperature plasma|Child