颈部食管憩室误诊甲状腺癌五例分析及文献复习
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摘要
目的探讨颈段食管憩室的临床特点、诊断和治疗方法,避免误诊甲状腺癌。方法回顾性分析颈段食管憩室误诊为甲状腺癌的临床资料,5例患者均术前误诊为甲状腺癌,其中Zenker憩室4例,Killian-Jamieson憩室1例,患者均系查体发现,术前无临床症状。结果 5例患者中行手术切除3例,观察1例,内翻缝合1例,无并发症发生,随访6个月到4年无复发。结论 Zenker憩室和Killian-Jamieson憩室具有不同的临床特征,甲状腺外科医师应该熟知,避免误诊和误治。
Objective The clinical manifestations,diagnosis and treatment of diverticulum in the cervical esophagus were investigated to avoid misdiagnosis. Methods We retrospectively analyzed 5 cases misdiagnosed of diverticulum of the cervical esophagus from 2009 to 2013 at our hospital. Results Diverticlum was resected in 3 cases,inward suture was done in one case,and observation was given in 1 case. No operative complications nor recurrence occurred during a follow-up for 6 months to 4 years. Conclusions Killian-Jamieson diverticulum and Zenker diverticulum have diferent clinical characteristics. Thyroid surgeons should have a sound knowledge about it so as to avoid misdiagnosis and treatment of diverticulum.
Objective The clinical manifestations,diagnosis and treatment of diverticulum in the cervical esophagus were investigated to avoid misdiagnosis. Methods We retrospectively analyzed 5 cases misdiagnosed of diverticulum of the cervical esophagus from 2009 to 2013 at our hospital. Results Diverticlum was resected in 3 cases,inward suture was done in one case,and observation was given in 1 case. No operative complications nor recurrence occurred during a follow-up for 6 months to 4 years. Conclusions Killian-Jamieson diverticulum and Zenker diverticulum have diferent clinical characteristics. Thyroid surgeons should have a sound knowledge about it so as to avoid misdiagnosis and treatment of diverticulum.
引文
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[3]Bonavina L,Bona D,Abraham M,et al.Long-term results of endosurgical and open surgical approach for Zenker diverticulum[J].World J Gastroenterol,2007,13(18):2586-2589.
[4]李阳,陈兴明,高志强.下咽及颈段食管憩室的诊断和治疗[J].中华医学杂志,2012,92(8):559-561.
[5]Bock JM,Petronovich JJ,Blumin JH.Massive Zenker diverticulum[J].Ear Nose Throat J,2012,91(8):319-320.
[6]Tang SJ,Tang L,Chen,et al.Flexible endoscopic Killian-Jamieson diverticulotomy and literature review(with video)[J].Gastrointest Endosc,2008,68(4):790-793.
[7]高万峰,石富,于兰,等.Killian-Jamieson憩室误诊为结节性甲状腺肿[J].临床误诊误治,2010,23(6):557.
[8]Lixin J,Bing H,Zhigang W.Sonographic diagnosis features of Zenker diverticulum[J].Eur J Radiol,2011,80(2):e9-13.
[9]刘海珍,郁春红,李照喜.咽食管憩室超声漏误诊分析[J/CD].中华医学超声杂志:电子版,2012,9(7):634-635.
[10]王深明,叶润仪.甲状腺微小癌诊断与外科治疗规范化[J/CD].中华普外科手术学杂志:电子版,2013,7(4):246-249.
[11]Kwak JY,Kim EK.Sonographic findings of Zenker diverticula[J].J Ultrasound Med,2006,25(5):639-642.
[12]曾敏霞,王燕,姜立新.咽食管憩室误漏诊10例分析[J].中国误诊学杂志,2012,12(6):1370.
[13]滕卫平,刘永锋,高明,等.甲状腺结节和分化型甲状腺癌诊治指南[J].中华内分泌代谢杂志,2012,28(10):779-797.
[14]周宏,姚陈,赖远辉,等.分化型甲状腺癌外科手术方式探讨[J/CD].中华普通外科学文献:电子版,2010,4(3):246-251.
[15]Constantin A,Mates IN,Predescu D,et al.Principles of surgical treatment of Zenker diverticulum[J].J Med Life,2012,5(1):92-97.
[16]Kim DC,Hwang JJ,Lee WS,et al.Surgical treatment of killianjamieson diverticulum[J].Korean J Thorac Cardiovasc Surg,2012,45(4):272-274.
[17]Case DJ,Baron TH.Flexible endoscopic management of Zenker diverticulum:the Mayo Clinic experience[J].Mayo Clin Proc,2010,85(8):719-722.
[2]Kitazawa M,Koide N,Saito H,et al.Killian-Jamieson diverticulitis with cervical cellulitis:report of a case[J].Surg Today,2010,40(3):257-261.
[3]Bonavina L,Bona D,Abraham M,et al.Long-term results of endosurgical and open surgical approach for Zenker diverticulum[J].World J Gastroenterol,2007,13(18):2586-2589.
[4]李阳,陈兴明,高志强.下咽及颈段食管憩室的诊断和治疗[J].中华医学杂志,2012,92(8):559-561.
[5]Bock JM,Petronovich JJ,Blumin JH.Massive Zenker diverticulum[J].Ear Nose Throat J,2012,91(8):319-320.
[6]Tang SJ,Tang L,Chen,et al.Flexible endoscopic Killian-Jamieson diverticulotomy and literature review(with video)[J].Gastrointest Endosc,2008,68(4):790-793.
[7]高万峰,石富,于兰,等.Killian-Jamieson憩室误诊为结节性甲状腺肿[J].临床误诊误治,2010,23(6):557.
[8]Lixin J,Bing H,Zhigang W.Sonographic diagnosis features of Zenker diverticulum[J].Eur J Radiol,2011,80(2):e9-13.
[9]刘海珍,郁春红,李照喜.咽食管憩室超声漏误诊分析[J/CD].中华医学超声杂志:电子版,2012,9(7):634-635.
[10]王深明,叶润仪.甲状腺微小癌诊断与外科治疗规范化[J/CD].中华普外科手术学杂志:电子版,2013,7(4):246-249.
[11]Kwak JY,Kim EK.Sonographic findings of Zenker diverticula[J].J Ultrasound Med,2006,25(5):639-642.
[12]曾敏霞,王燕,姜立新.咽食管憩室误漏诊10例分析[J].中国误诊学杂志,2012,12(6):1370.
[13]滕卫平,刘永锋,高明,等.甲状腺结节和分化型甲状腺癌诊治指南[J].中华内分泌代谢杂志,2012,28(10):779-797.
[14]周宏,姚陈,赖远辉,等.分化型甲状腺癌外科手术方式探讨[J/CD].中华普通外科学文献:电子版,2010,4(3):246-251.
[15]Constantin A,Mates IN,Predescu D,et al.Principles of surgical treatment of Zenker diverticulum[J].J Med Life,2012,5(1):92-97.
[16]Kim DC,Hwang JJ,Lee WS,et al.Surgical treatment of killianjamieson diverticulum[J].Korean J Thorac Cardiovasc Surg,2012,45(4):272-274.
[17]Case DJ,Baron TH.Flexible endoscopic management of Zenker diverticulum:the Mayo Clinic experience[J].Mayo Clin Proc,2010,85(8):719-722.