Clinical Study Of Radiofrequency Ablation In The Treatment Of Piriform Fossa Fistula

Purpose:Pyriform sinus fistula(PSF)originates from the abnormal development of the third,fourth branchial arch in embryonic stage.The traditional surgical procedure is open operation with external cervical path,but this method has many difficulties,such as difficult operation,postoperative complications and recurrence rate.In recent years,endoscopic minimally invasive surgery is another alternative method for the treatment of PSF because of its safety,easy operation.The purpose of this study is to explore the selection and curative effect of radiofrequency ablation(RA)in the treatment of PSF and analysis the role of B-ultrasonic examination in the postoperative follow-up of PSF.Methods:Prospective study of 37 cases of PSF in Shanghai Children’s Hospital,Department of Otolaryngology-Head and neck surgery from January 2016 to December 2017.There were 20 males and 17 females,and the ages ranged from 20 months to 10 years,the median age was 4 years old,the average age was 5.1 years old,35 cases occurred on the left side,two cases occured on the right side.Abscess incision and drainage was performed in 17 cases.26 cases were in the quiescent stage of inflammation,they were treated with RA for PSF.11 cases were in the inflammatory infection stage,they were treated with RA combined with abscess incision and drainage.The complications(hoarseness,neck swelling)and recurrence of all children were observed.At the same time,the laryngoscopy was checked for 3 months and 6 months after operation.The patients were examined by B-ultrasound before and after operation 1,3,6 months,and the three-dimensional size of the lesions was detected.The t square test was used to analyze the data.At the same time,35 cases of piriform fossa fistula with open operation were collected in our department.The operation time,the success rate and the complications of the two surgical methods were compared.Results:37 cases were treated with RA technique of cauterization of PSF.The nasal feeding was given for 2 weeks after the operation,3 cases had a temporary hoarseness after operation,and the sound improved and returned to normal one month after the operation.In 4 cases,there were swelling or abscess on the side of the affected side on the 3 day after operation,accompanied by fever.After incision and drainage of the neck abscess,the neck wound healed for one week.The laryngoscopy in 3 months and 6 months after the operation showed the closure of the internal opening in the pyriform fossa.B-ultrasound examination showed that the three-dimensional size of postoperative lesions was significantly reduced than that before operation.Compared with open surgery,RA for PSF was simpler and the operation time was shorter,but there was no significant difference between the success rate and postoperative complications.Conclusion:RA for PSF has the advantages of minimally invasive,easy to operate,less complications,low recurrence rate and safety,it has good curative effect in the treatment of quiescent stage and inflammatory infection of PSF,which provides a new way of thinking for the treatment of PSF in acute inflammatory period.B-ultrasound examination is a simple and valuable reference indicator for the postoperative follow-up.