本文選題：梨狀窩 + 瘺管　； 參考：《鄭州大學》2014年碩士論文

【摘要】：背景 先天性梨狀窩瘺是頭頸部的一種先天性疾病，常于兒童期發(fā)病，多見于左側(cè)，主要表現(xiàn)為反復發(fā)作的頸部膿腫或急性化膿性甲狀腺炎。該病臨床少見，國內(nèi)外文獻大多為個案報道，缺乏系統(tǒng)性的描述。食道造影、CT、喉鏡等檢查有助于該病的診斷。目前該病的治療以手術(shù)為主，傳統(tǒng)的手術(shù)方式是頸外進路將瘺管完整切除，通常需要解剖喉返神經(jīng)，同時將同側(cè)甲狀腺部分或全部切除。隨著對該病進一步的認識，近年來我們也采用內(nèi)鏡輔助下電凝封閉內(nèi)瘺口的方法治療先天性梨狀窩瘺并取得良好效果。 目的 分析總結(jié)先天性梨狀窩瘺的胚胎起源、解剖特點、臨床特征、診斷及治療方法。探討內(nèi)鏡輔助下電凝術(shù)和傳統(tǒng)開放性手術(shù)治療先天性梨狀窩瘺的臨床療效比較。 方法 回顧性分析2011年1月至2013年12月鄭州大學第一附屬醫(yī)院耳鼻咽喉頭外科收治的33例先天性梨狀窩瘺的病例，其中內(nèi)鏡下電凝術(shù)16例，傳統(tǒng)開放性手術(shù)17例，對兩種方法的手術(shù)時間、術(shù)后住院日、治愈率、復發(fā)率及并發(fā)癥等進行對比分析。 結(jié)果 傳統(tǒng)組與內(nèi)鏡組治愈率之間的差異有統(tǒng)計學意義（P＜0.05）；兩組間的手術(shù)時間差異有統(tǒng)計學意義（P＜0.05）；兩組的術(shù)后住院日差異無統(tǒng)計學意義（P＞0.05）。內(nèi)鏡組術(shù)后無并發(fā)癥，，6例復發(fā)；傳統(tǒng)組術(shù)后2例喉返神經(jīng)麻痹，1例復發(fā)。 結(jié)論 傳統(tǒng)開放性手術(shù)較電凝術(shù)治愈率高，但是手術(shù)時間長、創(chuàng)傷大、并發(fā)癥多；內(nèi)鏡下電凝術(shù)操作簡單、手術(shù)時間短、患者痛苦小、并發(fā)癥少，雖然復發(fā)率較開放性手術(shù)高，但仍值得嘗試。
[Abstract]:Background congenital piriform fossa fistula is a congenital disease of the head and neck, which often occurs in childhood and is more common on the left side. It is mainly characterized by recurrent cervical abscess or acute suppurative thyroiditis. The clinical manifestations of the disease are rare and most of the literature at home and abroad are case reports and lack of systematic description. Ct and laryngoscopy are helpful in the diagnosis of the disease. At present, the treatment of the disease is mainly surgery. The traditional surgical method is to remove fistula completely through external cervical approach, which usually requires dissection of recurrent laryngeal nerve and partial or total excision of ipsilateral thyroid gland. With the further understanding of the disease, endoscope-assisted electrocoagulation closure of internal fistula is also used to treat congenital piriform fossa fistula and good results have been obtained in recent years. Objective to analyze and summarize the embryonic origin, anatomical features, clinical features, diagnosis and treatment of congenital piriform fossa fistula. To evaluate the clinical efficacy of endoscopic assisted electrocoagulation and open surgery in the treatment of congenital piriform fossa fistula. Methods from January 2011 to December 2013, 33 cases of congenital piriform fossa fistula in the Department of Otorhinolaryngology, the first affiliated Hospital of Zhengzhou University, were retrospectively analyzed, including 16 cases of endoscopic electrocoagulation and 17 cases of traditional open surgery. The operative time, postoperative hospital stay, cure rate, recurrence rate and complications of the two methods were compared and analyzed. Results the difference of the cure rate between the traditional group and the endoscopic group was statistically significant (P < 0.05), the difference of operation time between the two groups was statistically significant (P < 0.05), and there was no significant difference in postoperative hospitalization days between the two groups (P > 0.05). No complications were found in 6 cases of recurrence in endoscopic group and 1 case of recurrent laryngeal nerve paralysis in 2 cases of recurrent laryngeal nerve palsy in traditional group. Conclusion the cure rate of traditional open surgery is higher than that of electrocoagulation, but the operation time is longer, the trauma is great, the complications are more, the endoscopic electrocoagulation is simple, the operation time is short, the patient's pain is small, the complication is less. Although the recurrence rate is higher than open surgery, it is still worth trying.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R762

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