[Diagnostic value of imaging and efficacy analysis of different surgical approaches for congenital pyriform sinus fistula in children].

Objective

To explore the clinical value of ultrasound and computed tomography（CT） in diagnosing congenital pyriform sinus fistula（CPSF）, and to compare the clinical efficacy of low-temperature plasma radiofrequency ablation under endoscopy with that of open cervical fistulectomy, so as to provide evidence for optimizing treatment strategies.

Methods

A retrospective analysis was conducted on the clinical data of 129 pediatric patients diagnosed with CPSF by suspension laryngoscopy in the Department of Otorhinolaryngology Head and Neck Surgery at Children's Hospital Affiliated to Kunming Medical University from January 2018 to June 2024. The patients were divided according to surgical approach into an endoscopic group （86 cases, 66.67%） and an open surgery group （43 cases, 33.33%）. The positive diagnostic rates of ultrasound and CT examination, as well as the detection of abscess formation and thyroid involvement, were analyzed for all patients. Differences between the two surgical methods were compared in terms of operative time, intraoperative blood loss, postoperative nasogastric tube indwelling time, length of hospital stay, complications, and recurrence.

Results

A total of 129 children were included with age ranging from 3 months to 15 years and 9 months （median age: 5 years and 4 months）. The male-to-female ratio was approximately 1.26∶1.00, and left-sided lesions accounted for 91.47%. There was no statistically significant difference in the overall positive diagnostic rates between ultrasound and CT（P>0.05）. However, CT was superior to ultrasound in detecting abscess formation and thyroid involvement（P<0.05）. Compared with open surgery, endoscopic surgery had shorter operative time and less intraoperative blood loss（P<0.05）, but slightly longer postoperative gastric tube retention and hospital stay. No statistically significant differences were observed between the two groups in postoperative complications or recurrence rates（P>0.05）.

Conclusion

Ultrasound is suitable for initial screening and follow-up of CPSF, while CT is more appropriate for precise lesion localization and preoperative evaluation. The combination of both modalities can improve diagnostic accuracy. Endoscopic low-temperature plasma radiofrequency ablation offers the advantages of minimal invasiveness and reduced intraoperative bleeding. It may be considered one of the preferred treatment options for suitable candidates; however, the final decision should be individualized based on the type of lesion and patient-specific factors.