先天性梨狀窩瘻管併發急性化膿性甲狀腺炎 － 病例報告

先天性梨狀窩瘻管是相當罕見的鰓器異常。目前認為其胚胎來源是第四鰓凹陷(branchial pouch)。好發於左側，由梨狀窩尖端部向下，穿出甲狀及環狀軟骨交界，通到甲狀腺旁或甲狀腺內，造成急性化膿性甲狀炎、頸部膿瘍、縱膈腔膿瘍等併發症。鋇劑吞嚥攝影以及直接喉鏡檢查可以確定診斷梨狀窩瘻管的存在。治療上宜先以靜脈注射抗生素控制感染，於急性期過後進行瘻管之完全切除，並考慮作部份甲狀腺切除術以減少復發的機會。本院於2001年12月經歷一主訴高燒及頸部疼痛性腫塊數週之10歲男童，經診斷為先天性梨狀窩瘻管併發急性化膿性甲狀腺炎，經抗生素治療兩週後進行瘻管切除手術，術後追蹤2個月無復發。因此病例罕見，特提出報告，並提醒臨床醫師，對於原因不明而反覆發生的頸部膿瘍或急性化膿性甲狀腺炎，應將先天性梨狀窩瘻管列入鑑別診斷。

關鍵字

先天性梨狀窩瘻管；急性化膿性甲狀腺炎；鰓器異常

並列摘要

Congenital pyriform sinus fistula (CPSF) is a rare branchial anomaly which originated from the fourth branchial pouch. Most of the cases reported in the literature were on left side. CPSF starts from the pyriform sinus apex, penetrates the cricothyroid junction, and ends in the perithyroid space or in the thyroid gland. CPSF may result in acute suppurative thyroiditis, cervical abscess or mediastinal abscess. The key to diagnosis of CPSF may result in acute suppurative thyroiditis, cervical abscess or mediastinal abscess. The key to diagnosis of CPSF is a high index of suspicion by the clinician. Barium swallow study and direct laryngoscopic examination are the diagnostic tools of choice. Intravenous antibiotics should be used during the acute infection stage. Complete excision of the fistula tract after infection control is the treatment of choice. Partial thyroidectemy may also be considered to avoid recurrence. In December 2001, we encountered a 10-year-old boy who suffered from high fever and tender neck mass for three weeks. He was diagnosed as congenital pyriform sinus fistula with acute suppurative thyroiditis after a series of examinations. After antibiotic treatment and fistulectemy, he recovered well and there was no recurrence at the 2 month follow-up. We report this case because CPSF is a rare disease entity. CPSF should be considered in the differential diagnosis of recurrent neck abscess or acute suppurative thyroiditis.

並列關鍵字

congenital phriform sinus fistula ； acute suppurative thyroiditis ； branchial anomaly

國際替代計量

先天性梨狀窩瘻管併發急性化膿性甲狀腺炎－病例報告

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