两种手术方式治疗先天性梨状窝瘘的临床疗效分析

发布时间：2018-06-19 17:02

本文选题：梨状窝 + 瘘管　；参考：《郑州大学》2014年硕士论文

【摘要】：背景先天性梨状窝瘘是头颈部的一种先天性疾病，常于儿童期发病，多见于左侧，主要表现为反复发作的颈部脓肿或急性化脓性甲状腺炎。该病临床少见，国内外文献大多为个案报道，缺乏系统性的描述。食道造影、CT、喉镜等检查有助于该病的诊断。目前该病的治疗以手术为主，传统的手术方式是颈外进路将瘘管完整切除，通常需要解剖喉返神经，同时将同侧甲状腺部分或全部切除。随着对该病进一步的认识，近年来我们也采用内镜辅助下电凝封闭内瘘口的方法治疗先天性梨状窝瘘并取得良好效果。目的分析总结先天性梨状窝瘘的胚胎起源、解剖特点、临床特征、诊断及治疗方法。探讨内镜辅助下电凝术和传统开放性手术治疗先天性梨状窝瘘的临床疗效比较。方法回顾性分析2011年1月至2013年12月郑州大学第一附属医院耳鼻咽喉头外科收治的33例先天性梨状窝瘘的病例，其中内镜下电凝术16例，传统开放性手术17例，对两种方法的手术时间、术后住院日、治愈率、复发率及并发症等进行对比分析。结果传统组与内镜组治愈率之间的差异有统计学意义（P＜0.05）；两组间的手术时间差异有统计学意义（P＜0.05）；两组的术后住院日差异无统计学意义（P＞0.05）。内镜组术后无并发症，，6例复发；传统组术后2例喉返神经麻痹，1例复发。结论传统开放性手术较电凝术治愈率高，但是手术时间长、创伤大、并发症多；内镜下电凝术操作简单、手术时间短、患者痛苦小、并发症少，虽然复发率较开放性手术高，但仍值得尝试。
[Abstract]:Background congenital piriform fossa fistula is a congenital disease of the head and neck, which often occurs in childhood and is more common on the left side. It is mainly characterized by recurrent cervical abscess or acute suppurative thyroiditis. The clinical manifestations of the disease are rare and most of the literature at home and abroad are case reports and lack of systematic description. Ct and laryngoscopy are helpful in the diagnosis of the disease. At present, the treatment of the disease is mainly surgery. The traditional surgical method is to remove fistula completely through external cervical approach, which usually requires dissection of recurrent laryngeal nerve and partial or total excision of ipsilateral thyroid gland. With the further understanding of the disease, endoscope-assisted electrocoagulation closure of internal fistula is also used to treat congenital piriform fossa fistula and good results have been obtained in recent years. Objective to analyze and summarize the embryonic origin, anatomical features, clinical features, diagnosis and treatment of congenital piriform fossa fistula. To evaluate the clinical efficacy of endoscopic assisted electrocoagulation and open surgery in the treatment of congenital piriform fossa fistula. Methods from January 2011 to December 2013, 33 cases of congenital piriform fossa fistula in the Department of Otorhinolaryngology, the first affiliated Hospital of Zhengzhou University, were retrospectively analyzed, including 16 cases of endoscopic electrocoagulation and 17 cases of traditional open surgery. The operative time, postoperative hospital stay, cure rate, recurrence rate and complications of the two methods were compared and analyzed. Results the difference of the cure rate between the traditional group and the endoscopic group was statistically significant (P < 0.05), the difference of operation time between the two groups was statistically significant (P < 0.05), and there was no significant difference in postoperative hospitalization days between the two groups (P > 0.05). No complications were found in 6 cases of recurrence in endoscopic group and 1 case of recurrent laryngeal nerve paralysis in 2 cases of recurrent laryngeal nerve palsy in traditional group. Conclusion the cure rate of traditional open surgery is higher than that of electrocoagulation, but the operation time is longer, the trauma is great, the complications are more, the endoscopic electrocoagulation is simple, the operation time is short, the patient's pain is small, the complication is less. Although the recurrence rate is higher than open surgery, it is still worth trying.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R762

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