Josephson Gary D, Black Kaelan
Division of Pediatric Otolaryngology-Head and Neck Surgery, Nemours Children's Clinic Jacksonville, Florida, USA
Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, USA.
Ann Otol Rhinol Laryngol. 2015 Dec;124(12):947-52. doi: 10.1177/0003489415593554. Epub 2015 Jul 26.
Literature review of treating the piriform apex sinus tract through microlaryngoscopy and a case description.
Fourteen papers were identified in PubMed using the search criteria of piriform sinus fistula, microlaryngoscopic repair, and endoscopy. Institutional Review Board approval was obtained.
One hundred forty-five cases including ours were available for review, with 182 procedures. Sixty-two cases were male, 73 female, and 10 genders were not reported. Multiple treatment options were used, including electrocautery, chemocautery, mass excision, fibrin glue, lasers, suture closure, or combination of stated modalities. Of the 182 procedures, 147 procedures were performed endoscopically. There were 37 recurrences (25%). These patients either underwent a repeat endoscopic procedure or an open excision. One hundred and ten (75%) endoscopic procedures were successful.
Piriform sinus tract anomalies often present as a mass and recurrent neck infections. This review reveals that treating the internal piriform sinus opening alone can be successful. This procedure has low morbidity, short operative time, and high success. We advocate this approach first with a combined open/laryngoscopic approach for failed cases. To our knowledge, our technique of CO₂laser ablation of the tract followed by suture closure has not been previously described. We believe this to be the first comprehensive review of this topic and the largest series of cases included in a single report.
通过显微喉镜治疗梨状尖窦道的文献综述及病例描述。
在PubMed中使用梨状窦瘘、显微喉镜修复和内窥镜检查的搜索标准确定了14篇论文。获得了机构审查委员会的批准。
包括我们的病例在内，共有145例可供审查，共进行了182次手术。其中男性62例，女性73例，10例未报告性别。采用了多种治疗方法，包括电灼、化学烧灼、肿物切除、纤维蛋白胶、激光、缝合封闭或上述方法的联合应用。在182次手术中，147次是通过内窥镜进行的。有37例复发（25%）。这些患者要么接受了重复的内窥镜手术，要么接受了开放性切除。110例（75%）内窥镜手术成功。
梨状窦道异常常表现为肿物和颈部反复感染。本综述表明，仅治疗梨状窦内口即可成功。该手术发病率低、手术时间短且成功率高。我们主张首先采用这种方法，对于失败的病例采用开放/喉镜联合方法。据我们所知，我们先采用二氧化碳激光烧灼窦道然后缝合封闭的技术此前尚未有描述。我们认为这是对该主题的首次全面综述，也是单一报告中纳入的最大病例系列。
