Nonomura N, Ikarashi F, Fujisaki T, Nakano Y
Department of Otolaryngology, Niigata University School of Medicine, Japan.
Am J Otolaryngol. 1993 Mar-Apr;14(2):111-5. doi: 10.1016/0196-0709(93)90049-d.
Congenital pyriform sinus fistula is recognized as a potential cause of recurrent cervical inflammation, recurrent abscess, and acute suppurative thyroiditis. Failure to recognize this diagnosis may result in recurrence following administration of antibiotics and incision and drainage. This study reflects the authors' experience in treating four patients with this diagnosis.
Patients included three children and one adult ranging in age from 7 to 34 years. The steps necessary to confirm the diagnosis and the subsequent surgical treatment are reviewed.
All fistula occurred on the left side. In each case the fistula originated in the apex of the pyriform sinus. It subsequently penetrated the inferior constrictor in three cases and the thyroid cartilage in one to end in the thyroid gland or perithyroid tissue. The opening of the pyriform sinus fistula could be identified by either barium swallow or direct endoscopy. Complete fistulectomy resulted in resolution of symptoms in all cases.
Pyriform sinus fistula is a rare entity. It may be of fourth branchial pouch origin. Identification of the fistula opening in the pyriform sinus may be difficult or impossible during acute inflammation because of edema. The authors advocate the fistula be exposed through incision of the inferior constrictor muscle, which facilitates total removal. Resection of the fistula, adjacent scar tissue, and a portion of the thyroid gland when the fistula is attached, should be regarded as essential steps in curing this entity.
先天性梨状窝瘘被认为是复发性颈部炎症、复发性脓肿和急性化脓性甲状腺炎的潜在病因。未能识别该诊断可能导致在使用抗生素及切开引流后复发。本研究反映了作者治疗4例该诊断患者的经验。
患者包括3名儿童和1名成人，年龄在7至34岁之间。回顾了确诊所需的步骤及后续手术治疗。
所有瘘管均发生在左侧。在每种情况下，瘘管均起源于梨状窝尖部。随后，3例穿透咽下缩肌，1例穿透甲状软骨，止于甲状腺或甲状腺周围组织。梨状窝瘘的开口可通过吞钡或直接内镜检查确定。完整的瘘管切除术使所有病例的症状得到缓解。
梨状窝瘘是一种罕见疾病。它可能起源于第四鳃囊。由于水肿，在急性炎症期间可能难以或无法识别梨状窝内的瘘管开口。作者主张通过切开咽下缩肌暴露瘘管，这有助于完全切除。切除瘘管、相邻瘢痕组织以及当瘘管附着时的部分甲状腺，应被视为治愈该疾病的必要步骤。
