Meng Lingdu, He Shiwei, Dong Rui, Zheng Shan, Chen Gong
Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai 201102, China.
Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai 201102, China.
Am J Otolaryngol. 2023 Mar-Apr;44(2):103747. doi: 10.1016/j.amjoto.2022.103747. Epub 2022 Dec 26.
Pyriform sinus fistula (PSF) diagnosis is often easily delayed and incorrect. Diagnostic values of modalities vary in different situations. The aim of this study was to recommend optimal schemes for diagnosing PSF at different ages and infection stages.
A search of PubMed, Embase, Cochrane Library, and CBM databases was conducted to identify articles written in Chinese and English concerning PSF diagnosis using keywords: "pyriform sinus fistula", "diagnosis", and relevant synonymous terms. Quality assessment was performed using the Joanna Briggs Institute (JBI) levels of evidence and critical appraisal checklist tool.
111 studies describing 3692 patients were included. The highest true positive rate (TPR) of ultrasonography was 66.67 % in adult cases. Computed tomography (CT) yielded a good TPR (approximately 73 %) in both neonatal and adult patients, and contrast-enhanced CT (84.21 %) was better in adult patients. Most children cases could be accurately diagnosed by barium swallow (BS) examination which was significantly different in acute and non-infection stages (AIS, NIS). Magnetic resonance imaging (MRI) produced a nice TPR in fetal cases (69.23 %) and neonatal cases (54.44 %). Laryngoscopy was also affected by infection stages. TPR of gastroscopy (GS) was the highest in children (86.36 %) and adult cases (87.50 %).
For fetal cases suspected of PSF, an MRI is recommended. MRI or CT is preferred for neonatal cases regardless of infection stages. Children and adult patients are advised to undergo GS during NIS or AIS, while BS is suggested for NIS. Contrast-enhanced CT can also diagnose adults with PSF in AIS.
梨状窝瘘（PSF）的诊断常常容易延误且不准确。不同检查方式的诊断价值在不同情况下有所差异。本研究旨在推荐针对不同年龄和感染阶段的PSF诊断的最佳方案。
检索PubMed、Embase、Cochrane图书馆和中国生物医学文献数据库（CBM），使用关键词“梨状窝瘘”“诊断”及相关同义词，以识别关于PSF诊断的中英文文章。采用乔安娜·布里格斯研究所（JBI）证据水平和批判性评价清单工具进行质量评估。
纳入了111项描述3692例患者的研究。超声检查在成人病例中的最高真阳性率（TPR）为66.67%。计算机断层扫描（CT）在新生儿和成人患者中均有良好的TPR（约73%），成人患者中增强CT（84.21%）效果更佳。大多数儿童病例可通过吞钡（BS）检查准确诊断，急性感染期（AIS）和非感染期（NIS）有显著差异。磁共振成像（MRI）在胎儿病例（69.23%）和新生儿病例（54.44%）中产生了较好的TPR。喉镜检查也受感染阶段影响。胃镜检查（GS）在儿童（86.36%）和成人病例（87.50%）中的TPR最高。
对于疑似PSF的胎儿病例，推荐进行MRI检查。无论感染阶段如何，新生儿病例首选MRI或CT。建议儿童和成人患者在NIS或AIS期间进行GS检查，而NIS时建议进行BS检查。增强CT也可诊断处于AIS的成人PSF病例。
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