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1、•论著・先天性梨状窝痿管的诊断与治疗桑建中路武豪娄卫华【摘要】目的探讨先天性梨状窝痿管(congenitalpyrifornisinusfistula,CPSF)的临床表现和治疗原则。方法对2007年1月至2011年1月经手术确认连接梨状窝与甲状腺叶痿管的7例CPSF患者资料进行分析。患者均表现为复发性左侧颈部低位脓肿或急性化脓性甲状腺炎，所有患者均有误诊病史，病程3~11年,均曾数次行切开引流或外科探査。急性感染期患者脓肿切开引流,炎性反应消退后进行检查和根治性手术。结果炎性反应静止期CT检查，均
2、可见左侧甲状腺叶深面及其周围间隙瘢痕组织增生;6例患者行X线顿餐检査.5例可见源于梨状窝的痿管。4例患者术前行直达喉镜检查,3例可见位于梨状窝尖部附近的痿口。手术切除痿管及左侧部分甲状腺叶，保护喉返神经。术后恢复顺利，未岀现永久性喉返神经麻痹或卬状腺功能低下等并发症。随访5~40个月，未见复发。结论对于有反复发作下颈部脓肿病史的患者，尤其位于左侧者，应髙度怀疑CPSF的存在,X线顿餐和CT检査是有效的诊断方法，完整切除痿管及受累甲状腺叶可治愈CPSF。【关键词】痿；下咽；鲍区；先天畸形；脓肿Diag
3、nosisandmanagementofcongenitalpyriformsinusfistulaSANGJian・zhong9LUWu-hao,LOUWei-hu(LDepartmentofOtorhinolaryngologyHeadandNeckSurgery^FirstAffiliatedHospitalofZhengzhouUniversity^Zhengzhou450052、ChinaCorrespondingauthor:LOUWei-hua,Email:louweihuazzu@1
4、63.com[Abstract]ObjectiveToexploretheclinicalpresentationandmanagementprinciplesofcongenitalpyriformsinusfistula.MethodsSevensequentialcasesofcongenitalpyriformsinusGstula(CPSF)treatedbetweenJanuary2007andJanuary2011werereported・Theclinicalpresentation
5、wererecurrentleftlowerneckabscessoracutesuppurativethyroiditis.Allofthesepatientshadpasthistoriesofmisdiagnosisrangedfrom3yearsto11years・Allthepatientshadundergoneincisionanddrainageseveraltimes・Inacuteinfectionperiod,thesepatientsreceivedincisionanddr
6、ainage,afterinflammationsusided,weretreatedwithdefinitivesurgery・ResultsAfterbariumswallowstudyandCTexaminationinthequiescentstageofinfection,5patientscouldbeseenfistulainthepyriform,alllhepatientswerefoundscartissueneartheleftthyroidlobe,4patientsrece
7、iveddirectlaryngoscopeexaminationand3ofthemcouldbefoundinnerorificeneartheapexofpyrifbrmsinus,fistulaandtheinvolvedlobeofthyroidweresuccessfullyexcisedwithoutpermanentrecurrentlaryngealnerveinjuryorhypothroidism・Allthepatientshadanuneventfulrecoveryand
8、remainedsymptomfreefrom5monthsto40months.ConclusionsTheclinicalhistoryofrecurrentlowneckiriflamniatoryepisodesinpatients,especiallyontheleftside,shouldraisethesuspicionofCPSF.investigationusingbariumswallowincombinationwithCTscanningisu
