Wang Shengcai, Mei Lin, Li Yanzhen, Zhang Xuexi, Zhang Jie, Ge Wentong, Guo Yongli, Yu Yongbo, Wang Guoli, Mei Tianlu, Liu Qiaoyin, Sun Nian, He Yuzhu, Li Xiaodan, Liu Yuwei, Tai Jun, Ni Xin
Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, China.
Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (NCCH), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Front Pediatr. 2021 Jan 25;8:541249. doi: 10.3389/fped.2020.541249. eCollection 2020.
The aim of this study was to explore the diagnostic value of gastroscopy under local anesthesia for congenital pyriform sinus fistula (CPSF). This research was a diagnostic study. Patients received gastroscopy under local anesthesia to diagnose CPSF, and suspension laryngoscopy under general anesthesia was performed 2 days after gastroscopy. Various conditions of the internal opening of CPSF were then recorded. Patients were grouped according to lesion sides, age, time after the inflammation subsided, and history of previous surgery. The sensitivity, specificity, area under the receiver operating characteristic curve (AUC), accuracy, and positive and negative predictive values of gastroscopy were compared between the groups. A total of 48 patients were recruited in this study, and no patients had severe gastroscopy-related complications. The diagnostic values of gastroscopy in 41 cases (85.4%) were consistent with suspension laryngoscopy. The sensitivity of gastroscopy was 86.4%, the specificity was 75%, the AUC was 0.807, the positive prediction rate was 97.4%, the negative prediction rate was 33.3%, the accuracy rate was 85.4%, and the diagnostic odds ratio (DOR) was 2.1. The kappa consistency test results had statistical significance ( = 0.0026, kappa = 0.3913). The diagnostic value of gastroscopy was better for the patients with inflammation subsiding for more than 4 weeks ( < 0.0001). Gastroscopy under local anesthesia is a safe, effective, reliable and novel diagnostic method for CPSF, and it is especially recommended as a diagnostic method for the patients with inflammation subsiding for more than 4 weeks.
本研究旨在探讨局部麻醉下胃镜检查对先天性梨状窝瘘（CPSF）的诊断价值。本研究为诊断性研究。患者接受局部麻醉下的胃镜检查以诊断CPSF，并在胃镜检查2天后进行全身麻醉下的悬吊喉镜检查。然后记录CPSF内口的各种情况。根据病变侧、年龄、炎症消退时间及既往手术史对患者进行分组。比较各组之间胃镜检查的敏感性、特异性、受试者操作特征曲线下面积（AUC）、准确性以及阳性和阴性预测值。本研究共纳入48例患者，无患者发生严重的胃镜相关并发症。41例（85.4%）患者胃镜检查的诊断价值与悬吊喉镜检查结果一致。胃镜检查的敏感性为86.4%，特异性为75%，AUC为0.807，阳性预测率为97.4%，阴性预测率为33.3%，准确率为85.4%，诊断比值比（DOR）为2.1。kappa一致性检验结果具有统计学意义（P = 0.0026，kappa = 0.3913）。对于炎症消退超过4周的患者，胃镜检查的诊断价值更佳（P < 0.0001）。局部麻醉下的胃镜检查是一种安全、有效、可靠且新颖的CPSF诊断方法，尤其推荐作为炎症消退超过4周患者的诊断方法。
