The Comparative Analysis Of Therapeutic Effect Of Endoscopic CO₂ Laser Cauterization Or Open Neck Resection For Congenital Pyriform Sinus Fistula

Objective:We retrospectively analyzed 55 cases of congenital piriform sinus fistula?29males and 26 females?who were admitted to the department of otolaryngology head and neck surgery in the first hospital of jilin university from September 2009 to September 2019.And the patients underwent endoscopic CO₂ laser cauterization surgery or open neck resection.According to the different surgical methods,the patients were divided into the endoscopic group or open group.There were 23patients in the endoscopic group,including 10 males and 13 females,aged from 1 to58 years old,with a median age of 5 years old.And there were 32 patients in the open group,including 19 males and 13 females,aged from 0.4 to 60 years,with a median age of 7.5 years.By searching for hospitalization records and follow-up record,We obtained the preoperative,intraoperative,postoperative and follow-up situation.And we found whether there were the difference of statistics between two groups,including their age,sex,history of present illness,intraoperative,intraoperative blood loss,operation time,length of hospital stay,hospital expenses,length of indewlling gastric tube,postoperative complications and postoperative follow-up results.According to the above results,we evaluated the clinical curative effect of two kinds of operations.If P<0.05,it could be considered as statistically significant.Results:In the endoscopic group,23 patients were followed up for 6 months to 53 months,with an average of 22.4 months.There were six cases of recurrence,with a recurrence rate of 26.1%.And all the patients had no postoperative complications.In the open group,32 patients were followed up for 6 months to 119 months,with an average of41.9 months.There were only one case of recurrence,with a recurrence rate of3.1%.And two patients had postoperative complications,accounting for 6.3%of the total.Among them,one patient had temporary vocal cord paralysis after surgery,and the symptoms disappeared in half a year.The other patient had pharyngeal fistula after surgery and recovered well by enhancing dressing change.By using the chi-square test,there was no statistically significant difference between the two groups in gender,age,main symptoms,multiple infections,history of infection or incision drainage,and site?P>0.05?.By using Welch and brown-forsythe variance test,the differences in intraoperative blood loss,operation time,length of stay and operation cost and length of indewlling gastric tube between the two groups were statistically significant?P<0.05?.So we could conclude that the above five quantitative factors of endoscopic CO₂ laser cauterization are superior to those of open neck resection.By using the Fisher exact probability comparison,there was no statistically significant difference in postoperative complications between the two groups?P>0.05?.By using adjusted chi-square test,the difference in recurrence rate between two groups was statistically significant?P<0.05?,we concluded that the recurrence rate of open neck resection was lower than that of endoscopic CO₂ laser cauterization.Conclusions:1.When comparing surgical methods for congenital piriform sinus fistula,although the cure rate of open neck fistulectomy surgery is higher than endoscopic CO₂ laser cauterization,the time of operation and hospitalization is long,the cost is relatively high,the trauma is large,the recovery is slow,and it may occur postoperative complications.2.Endoscopic CO₂ laser cauterization as a minimally invasive treatment has many advantages,such as simple and repeatable operation,safe,beautiful,little injury and pain,rapid recovery and the distinctly curative effect.Compared to open surgery,the recurrence rates of endoscopic CO₂ laser cauterization were slightly higher,but it is still worth advocating and use.We suggest that endoscopic CO₂ laser cauterization can be used as a preferred surgical technique for patients with congenital piriform sinus fistula,the type of fistula and sinus tract.