Pyriform sinus fistula: Management with chemocauterization of the internal opening
Pyriform sinus fistula: Management with chemocauterization of the internal opening
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DOI：
10.1177/000348940010900503
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发表时间：
2000-05-01
影响因子：
1.4
通讯作者：
Kim, IS
中科院分区：
文献类型：
--
作者：
Kim, KH;Sung, MW;Kim, IS
起源于梨状窝的鳃裂残端可引起颈部复发性瘘管或脓肿。尽管进行了切除，但瘘管切除不充分仍可能导致复发。我们尝试在直接内视镜下以三氯乙酸（TCA）化学烧灼瘘管的内部开口。本文对18例梨状窝瘘患者进行了6年的回顾性分析。分析病史、钡剂食管造影、计算机断层扫描、手术发现和治疗结果。经直接内视镜检查，所有患者均发现梨状窦内有瘘管开口。仅在左侧。只有9例患者在术前通过食管钡剂造影确定了瘘道。计算机断层扫描显示10例患者中有8例患者的可疑瘘管起源于梨状窦。16例患者最初通过TCA化学烧灼治疗。无严重术中或术后并发症。4例患者有复发性肿块，其中2例患者通过简单切除和2例内部开口未闭塞的患者重复TCA烧灼治疗。我们建议对所有复发性侧颈脓肿的患者，尤其是左侧的患者，进行吞钡检查和直接内镜检查。我们的研究结果表明，初步化学烧灼术的内部开口可以是一个合理的替代程序的管理梨状窝瘘。
A branchial remnant originating in the pyriform sinus causes a recurrent fistula or abscess in the neck. In spite of excision, recurrence may result from inadequate removal of the fistula tract. We attempted chemocauterization of the internal opening of the fistula tract with trichloroacetic acid (TCA) on direct endoscopy. This is a 6-year review of 18 patients with pyriform sinus fistula. Medical history, barium esophagography, computed tomography scans, operative findings, and treatment results were analyzed. By direct endoscopy, all patients were found to have a fistula opening in the pyriform sinus. exclusively on the left side. In only 9 patients, the fistula tract was identified by barium esophagography before operation. Computed tomography revealed a suspicious fistula tract originating from the pyriform sinus in 8 of 10 patients. Sixteen patients were initially managed by TCA chemocauterization. There were no serious intraoperative or postoperative complications. Four patients had recurrent masses, which were managed by simple excision in 2 patients and repeated TCA cauterization in the other 2 patients with unobliterated internal openings. We recommend barium swallow study and direct endoscopy for all patients presenting with a recurrent lateral neck abscess, especially on the left side. Our results suggest that initial chemocauterization of the internal opening can be a reasonable alternative procedure for the management of pyriform sinus fistula.