術中痩菅確認が困難であった下咽頭梨状窩瘻の1症例と本邦報告例の集計

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A five-year-old boy with left pyriform sinus fistula was presented. He repeated the episodes of redness and swelling in the anterior neck. Diagnosis was made by esophagogram. We firstly performed fistelectomy, but the same symptoms recurred at the six months after surgery. At the time of the second operation, we inserted a catheter and poured indigocarmine into the fistula for easy detection. We however couldn't detect the fistula. Then we performed pharyngotomy and removed the fistula with caudal portion of pyriform sinus. Histological examinations showed a tubular structure lined by a pseudostratified ciliated epithelium. The ectopic thymus was found by the fistula. The thyroid tissue was noted to have interfollicular fibrosis and lymphocytic infiltration. Seventy four cases of pyriform sinus fistulae, ours included, were reviewed in Japanese literature. First sign of symptoms started about 7.5 years of age, on the average, with exceptions those of four adult cases. There is no sex difference in frequency. Sixty nine patients had the fistula on the left side of the pyriform sinus. Esophagogram was usualy of value for it's diagnosis. It is very important for a permanent cure to detect the fistula and to excise it in operation. Although 47 out of 74 patients had a fistulectomy in literature, 4 patients had a recurrence. We would like to recommend pharyngotomy and excision of pyriform sinus fistula for the case of re-current cases after fistulectomy and the undetectable fistula.
日本小児外科学会の論文
1989-02-20

術中痩菅確認が困難であった下咽頭梨状窩瘻の1症例と本邦報告例の集計

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