目的:梨状窝瘘(PSF)的外科治疗方法正在改进。这项研究的目的是探讨部分瘘管切除术在使用亚甲蓝辅助PSF儿童中的效果。
方法:根据用于治疗PSF感染的方法,将患者分为保守治疗组,单切口组(儿童通过环甲关节皮纹处的切口引流脓肿),非单切口组(儿童通过脓肿或溃疡最明显区域的切口引流脓肿)。数据来自电子病历(EMR)和医院信息系统(HIS)。比较瘘管切除术后6个月患者和观察者瘢痕评估量表(POSAS)评分。
结果:共有239例诊断为PSF的患者采用亚甲蓝通过宫颈入路部分切除瘘管。手术成功率为100%。平均手术时间为32±13.2min。平均住院时间为1±0.2天。出现一过性声音嘶哑2例,伤口感染6例。保守治疗组17例,单切口组81例,非单切口组145例。三组POSAS平均评分分别为2.56±0.6,3.12±0.84和4.56±1.56,三组间差异有统计学意义(P<0.05)。
结论:通过颈部单切口使用亚甲蓝辅助部分瘘管切除术治疗儿童PSF成功率高,与传统手术相比,术后并发症少,舒适度高。这种替代手术可用于治疗儿童PSF。
OBJECTIVE: The surgical treatment of pyriform sinus fistula (PSF) is improving. The aim of this study was to investigate the effect of partial fistula excision in children with PSF assisted by using methylene blue.
METHODS: According to the method used to treat PSF infection, the patients were divided into a conservative treatment group, a single incision group (the children drained the abscess through the incision at the dermatoglyph of the cricothyroid joint), and a non single incision group (the children drained the abscess through the incision in the most obvious area of the abscess or ulceration). The data were retrieved from the electronic medical records (EMRs) and hospital information system (HIS). The patient and observer scar assessment scale (
POSAS) scores at 6 months after fistula resection were compared.
RESULTS: A total of 239 patients diagnosed with PSF underwent partial resection of the fistula through cervical approach with methylene blue. The success rate of the operation was 100%. The average operation time was 32 ± 13.2 min. The average hospital stay was 1 ± 0.2 days. There were 2 cases of transient hoarseness and 6 cases of wound infection. There were 17 patients in the conservative treatment group, 81 patients in the single incision group and 145 patients in the nonsingle incision group. The average
POSAS scores of the three groups were 2.56 ± 0.6, 3.12 ± 0.84 and 4.56 ± 1.56, respectively, with significant differences among the three groups (P < 0.05).
CONCLUSIONS: Partial fistulectomy assisted by using methylene blue through a single incision in the neck for the treatment of PSF in children yields a high success rate, fewer postoperative complications and greater comfort than traditional surgery. This alternative surgery can be used to treat PSF in children.