Comparison Of The Efficacy Of Endoscopic Holmium-laser And Fistulectomy For Congenital Pyriform Sinus Fistula

Objective: Congenital pyriform sinus fistula(CPSF)is a branchial apparatus disease caused by early embryonic failure of the pharyngeal sac or gills arch to fuse or atresia.According to morphological classification,it can be divided into fistula,sinus and cyst.Clinical manifestations include neck swelling and pain,recurrent neck abscess,neck fistula,local skin temperature rise,acute suppurative thyroiditis,cervical lymph node enlargement,etc.Fistulectomy is the main treatment for congenital pyriform sinus fistula.In traditional fistulectomy,fistula or sinus tract is dissected through the external neck approach.However,due to repeated local infection and dense adhesion of fistula and surrounding tissues,fistula is difficult to find or incomplete resection during operation,which often leads to recurrence.With the development of minimally invasive technique,due to the pharyngeal secretion as the main reasons for the infection and cystic changes of the pyriform fistula,for patients with the piriform sinus,the fistula in the piriform sinus was treated using electric cautery,chemical cautery,laser cautery,biological glue plugging and suture.Therefore,this study aims to provide more clinical references for congenital pyriform sinus fistula by comparing the clinical efficacy of endoscopic holmium-laser cauterization and traditional fistulectomy via external cervical approach.Methods:A retrospective analysis was conducted on 11 children with congenital piriform sinus fistula treated using endoscopic holmium-laser cauterization from May 2019 to December 2020 and 13 children underwent fistulectomy through an outside cervical approach from 2015 to 2019 in the Second Hospital of He Bei Medical University.The operation time,incision length,intraoperative blood loss,postoperative feeding time,postoperative hospital stay,recurrence rate and hospitalization costs were compared in two groups.The white blood cell count,the percentage of neutrophils and the hypersensitive C-reactive protein before surgery,24 hours after surgery and before discharge in the two groups was also compared respectively.Regular follow-up the barium swallow X-ray(BSX),the neck color doppler ultrasonography(US)or the computed tomography(CT)during the reexamination.Whether it recurred,the time between the last operation and the treatment after recurrence were also regular followed-up.Results:Compared with the transcervical approach sinus fistula resection group,the endoscopic holmium-laser group had shorter operation time(38.18±6.03 min vs.94.04±12.08 min,P=0.007),shorter incision length(0.26±0.05 cm vs.3.98±1.05 cm,P=0.000),less intraoperative bleeding(0.13±0.12 ml vs.6.35±5.94 ml,P=0.000),earlier postoperative feeding(30.55± 9.84 h vs.57.20±16.73 h,P=0.040),shoter postoperative hospital stay(3.73±0.79 d vs.7.46±1.90 d,P=0.029),lower recurrenc(1 vs 4,P<0.01)and less hospitalization costs(9627.73±1154.34 CNY vs.16286.62±3854.86 CNY,P=0.048).There were significant differences in the morphological classification and recurrence rate of fistula between the two groups(P<0.05),the holmium-laser cauterization group had a single morphological classification of fistula and a lower recurrence rate.There were statistically significant differences in the changes of inflammatory indexes such as white blood cell count(WBC),neutrophil percentage(NEUT)and hypersensitive C-reactive protein(hs CRP)before surgery and 24 hours later and before discharge between the two groups(P<0.05).There were no statistical differences between the two groups in gender,age,main symptoms,site of disease(P>0.05).Conclusions:Endoscopic holmium-laser cauterization as a new technique for congenital pyriform sinus fistula,it has high precision,less trauma,fewer recurrence,shorter postoperative recovery time,fine cosmetic effect and it is easy to operation,which reduce the risk of damage in the important structure in the neck external open surgery and avoid the problem of repeated infection or multiple surgery,proven to be a safe and effective procedure,which can be used as an alternative treatment for congenital pyriform sinus fistula.