Kong Chihuan,Wu Yurui,Li Long,et al.Role of gastroscopy during operation of piriform fossa fistula in children[J].Journal of Clinical Pediatric Surgery,2025,(09):877-881.[doi:10.3760/cma.j.cn101785-202312005-014]
胃镜联合手术在预防儿童梨状窝瘘复发中的作用
- Title:
- Role of gastroscopy during operation of piriform fossa fistula in children
- Keywords:
- Piriform Fossa Fistula; Gastroscopy; Surgical Procedures; Operative; Child
- 摘要:
- 目的 初步探讨胃镜在儿童梨状窝瘘手术全过程中的作用。方法 回顾性分析2020年12月至2021年7月于首都医科大学附属首都儿童医学中心普外科接受治疗的5例梨状窝瘘患儿临床资料，收集复发因素及诊治经过，总结诊治经验。结果 本组共5例患儿，女3例、男2例；年龄2岁8个月至11岁，平均年龄4岁9个月。5例既往均有手术史：3例行颈部左侧脓肿切开引流术，2例行左侧瘘管切除术；5例均因同侧复发再次来我院诊治。术前行颈部超声5例，行上消化道造影5例，行CT、MRI各1例；其中1例行上消化道造影时示双侧梨状窝瘘。5例术中均完整游离瘘管至瘘管内口黏膜下，并结扎内口和切除瘘管。术后均未出现声音嘶哑等症状，次日开始进食，抗炎治疗3 d后出院。术后病理提示：送检组织为被覆柱状上皮、鳞状-柱状上皮管腔。术后随访1年以上均未见复发。结论 梨状窝瘘管内的确存在上皮组织。瘘管的全部切除和瘘管内口的完整结扎是防止梨状窝瘘术后复发的关键步骤。由于胃镜在手术全过程的应用，使颈部入路手术能够完整剥离瘘管并关闭瘘管内口，不仅能够避免误伤周边组织，更能够有效避免术后复发。
- Abstract:
- Objective To explore the role of gastroscopy during operation of pediatric piriform sinus fistula (PSF). Methods A retrospective analysis was conducted for the relevant clinical data of 5 children hospitalized with PSF from December 2020 to July 2021.The recurrence factors and managements were collected and diagnostic and therapeutic experience summarized. Results In this cohort, there were 2 boys and 3 girls with an average age of 57(32-132) month.All of them had a previous history of surgery.There were incision/drainage of left cervical abscess (n=3) and left fistulotomy (n=2).They were re-hospitalized for psilateral recurrence of PSF.Preoperative neck ultrasound and upper gastrointestinal imaging were performed along with computed tomography (CT) and magnetic resonance imaging (MRI).Bilateral PSF was detected during upper gastrointestinal imaging.Under the same anesthesia, gastroscopy was performed.In all 5 cases, fistula was completely freed to submucosal area of fistula opening.Internal opening was ligated and fistula was removed.There was no postoperative hoarseness.Eating resumed the next day and discharge occurred after 3-day anti-inflammatory treatment.Postoperative pathological examination revealed that submitted tissue consisted of covered columnar epithelium and squamous columnar epithelial lumens.Follow-up for more than 1 year after surgery showed no recurrence. Conclusions Epithelial tissue is present in piriform sinus fistula.A complete removal of fistula and a complete ligation of fistula opening are essential for preventing postoperative recurrence of PSF.Due to the application of gastroscopy during the entire surgical process, cervical approach surgery can completely remove fistula and close fistula opening.It not only avoids accidental injury to surrounding tissues but also effectively prevents postoperative recurrence.
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备注/Memo
收稿日期:2023-12-3。
基金项目:中国医学科学院小儿外科微创诊疗创新单元(2021RU015)
通讯作者:李龙，Email: lilong23@126.com