摘要
背景: 急性化膿性甲狀腺炎相當罕見，一般認為與梨狀窩瘻管有關。本研究回顧馬偕紀念醫院治療急性化膿性甲狀腺炎的經驗，希望藉此建立一套這類患者的處理原則。 方法: 自1990年1月至2001年12月，共計16名急性化膿性甲狀腺炎的患者曾於馬偕紀念醫院接受治療。我們將其性別、年齡、膿瘍的位置及大小、臨床症狀、致病菌、檢查結果、治療方式、住院天數、復發情形予以整理分析。 結果: 16名患者中，男性5名，女性11名，年齡分佈從1.1歲至67.3歲。13名發生於左葉，3名發生於右葉。鍵球菌為最常見的致病菌。3名患者的甲狀腺功能異常。1名患者經喉纖維內視鏡發現梨狀窩瘻管，3名患者經鋇劑食道攝影發現梨狀窩瘻管。7名患者曾接受膿瘍切開引流。平均住院天數為11.3天。5名患者有復發情形。 結論: 臨床醫師在治療急性化膿性甲狀腺炎時應注意是否有同時存在梨狀窩瘻管。而鋇劑食道攝影及直接喉頭鏡是診斷梨狀窩瘻管較佳的方法。急性化膿性甲狀腺炎經抗生素及切開引流治療後，若能施行瘻管切除，應可降低復發機率。
並列摘要
BACKGROUND: Acute suppurative thyroiditis (AST) is very rare. Pyriform sinus fistula (PSF) is implied as a cause of AST. This study reflects our experience in treating patients with AST and proposes a protocol for the work-up and management of patients. METHODS: Tracing back cases diagnosed as AST in Mackay Memorial Hospital from January 1999 to December 2001, 16 cases were found. The sex, age, site and size of abscess, clinical presentation, pathogen, results of examination, treatment, duration of admission, and recurrence were analyzed. RESULTS: There were 5 male and 11 female. Their ages ranged from 1.1 to 67.3 years. Thirteen cases occurred in left lobe and 3 cases occurred in right. Streptococcus was the most common pathogen. Abnormal thyroid function was noted in 3 cases. One PSF was found by fiberoptic laryngoscopy, and 3 PSF were found by barium esophagogram. Seven cases have ever received incision and drainage. The average duration of admission was 11.3 days. Recurrent AST was noted in 5 cases. CONCLUSIONS: The clinician must be aware of a possible PSF in patients with AST. Barium esophagogram and direct laryngoscopy are optimal tools to search the PSF. Following administration of antibiotics and incision and drainage, fistulectomy can minimize the recurrence of AST.