Objective: To investigate the anatomic tract of congenital pyriform sinus fistula (CPSF). Methods: A total of 90 patients with CPSF undergoing open surgery between August, 2007 and March, 2017 at the Department of Guangdong General Hospital were retrospectively analyzed. Results: The tracts of all the fistulas actually walked far different from those of theoretical ones. A whole fistula may be divided into 4 segments according to adjacent anatomy of CPSF. The posterior inner segment to the thyroid cartilage was initial part of the fistula. It originated from the apex of pyriform sinus, then piercing out of the inferior constrictor of pharynx inferiorly near the inferior cornu of the thyroid cartilage (ICTC), and descended between the lateral branch of the superior laryngeal nerve and the recurrent laryngeal nerve. The ICTC segment was the second part of the fistula, firstly piercing out of the inferior constrictor of pharynx and/or cricothyroid muscle, and then entering into the upper pole of thyroid. The relationship between fistula and ICTC could be divided into three types: type A (medial inferior to ICTC) accounting for 42.2% (38/90); type B (penetrate ICTC) for 3.3% (3/90); and type C (lateral inferior to ICTC) for 54.5% (49/90). The internal segment in thyroid gland was the third part of fistula, walking into the thyroid gland and terminating at its upper pole (92.2%, 83/90) or deep cervical fascia near the upper pole of thyroid (7.8%, 7/90). The lateral inferior segment to thyroid gland was the last part of the fisula, most of which are iatrogenic pseudo fistula, and started from the lateral margin of thyroid gland. Conclusions: CPSF has a complicated pathway. Recognition of the tract and adjacent anatomy of CPSF will facilitate the dissection and resection of CPSF in open surgery.
目的： 探讨先天性梨状窝瘘瘘管的实际走行、分段及毗邻解剖，为开放性手术提供指导。 方法： 回顾分析广东省人民医院2007年8月至2017年3月诊治的资料完整的90例接受开放性手术的先天性梨状窝瘘瘘管(congenital pyriform sinus fistula，CPSF)患者的病历资料。 结果： 所有瘘管实际走行与理论走行迥异，依据瘘管走行及毗邻解剖，将其分为4段，甲状软骨翼板后内段是起始段，自梨状窝底部发出，在甲状软骨下角附近穿出咽下缩肌，在喉上神经外侧支与喉返神经入喉处之间下行；甲状软骨下角(inferior cornu of the thyroid cartilage，ICTC)段为瘘管穿出咽下缩和/或环甲肌处至其进入甲状腺上极处，瘘管与ICTC关系可分3型：A型(ICTC内下缘)发生比例为42.2%(38/90)、B型(穿ICTC)发生比例为3.3%(3/90)、C型(ICTC外下缘)发生比例为54.5%(49/90)；甲状腺腺体内段为瘘管穿入甲状腺上极后，在腺体内走行的部分，92.2%(83/90)的患者终于腺体内，7.8%(7/90)的患者终于甲状腺上极邻近的颈深部筋膜。甲状腺腺体外下段起自甲状腺腺体后外侧缘，是自然溃破或医源性切开继发的假性瘘道。 结论： CPSF瘘管走行复杂，各段与中下颈重要解剖结构关系密切。熟识瘘管实际走行、分段及毗邻解剖，有利于瘘管精确定位、精细解剖和精准切除。.
Keywords: Anatomy; Congenital abnormalities; Congenital pyriform sinus fistula.