【作者】 余静；

【导师】 吕麟亚；

【作者基本信息】 重庆医科大学 ， 临床医学（专业学位）， 2019， 硕士

【摘要】 目的:探讨儿童先天性梨状窝瘘解剖学特征,并分析对比在解剖基础上设计的改良手术与传统手术方法的疗效。方法:收集2012年7月-2018年7月于重庆医科大学附属儿童医院明确诊断为先天性梨状窝瘘的54例患儿病例资料。根据手术方式分为两组,传统手术组34例,经甲状腺平面或外瘘口平面手术入路;改良手术组20例,经甲状软骨下角手术入路,术中分析梨状窝瘘管解剖走行,测量瘘管各部分长度和直径,对比两组手术时间、术中出血、切口长度、住院时间、根治率、并发症发生率及术后复发率,分析传统手术和改良手术的疗效。结果:梨状窝瘘管分为漏斗部和移行部,漏斗部固定位于甲状软骨下角后方或侧方,瘘管移行部可终止于甲状腺上极、经甲状腺旁到达皮肤或直接到达皮肤形成外瘘口。对比手术时间、术中出血及切口长度、住院时间、术后复发率,改良组均小于传统组(p<0.01)。术后随访6-18月,传统组复发率达29.4%,改良组未见复发。结论:基于解剖基础的经甲状软骨下角入路的手术方法,相比于传统手术,具有切口易定位、较美观,手术路径短,操作更便捷,术中瘘管易寻,术后恢复快,复发率低等特点,是可以参考的一种微创根治梨状窝瘘手术方法。更多还原

【Abstract】 Objective: To investigate the anatomical characteristics of congenital piriform sinus fistula in children and to design a minimally invasive surgical method.Methods: From July 2012 to July 2018,54 cases with CPSF were divided into two groups.Traditional group were thyroid or external fistula plane approach in 34 patients,while modified group were inferior horn of thyroid cartilage approach in 20 patients.The anatomical chamcteristics about CPSF was then studied,The following data were compared between 2 groups:incision length,operation time,intraoperative blood loss,hospital stay,the rate of radical operation,complication and postoperative recurrence were analyzed.Results: Fistula is divided into infundibular and transitional parts.Infundibular traversed behind or on the side of the posterioinferior cornu.Fistula has three types:with terminal at the upper pole of the thyroid,or reaching the skin via the thyroid or reaching the skin directly.The operative time,intraoperative bleeding,incision length,hospital stay and recurrence rate in the modified group were lower than those in the traditional group(p< 0.01).After 6-18 months follow-up,the recurrence rate was 29.4% in the traditional group,but no recurrence was found in the modified group.Conclusion: Piriform fossa fistulectomy was performed through posterioinferior cornu with advantages such as short operation path,quick recovery,and low recrudescence rate.It was a better choice in management of PSF owing to its safe and effective.更多还原