感染性先天性耳前瘘管病理组织学观察  

Congenital preauricular fistula infection:a histopathology observation

作　　者：华娜[1] 卫来[1] 姜涛[1] 郭颖[1] 王美熠[1] 王志强[1] 

机构地区：[1]大连大学附属中山医院耳鼻咽喉科,辽宁大连116001

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第16期1229-1232,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的：探讨感染性先天性耳前瘘管的病理组织学特点，为降低术后复发率、改进手术方法提供依据。方法：收集感染性耳前瘘管患者25例，其中有感染史非感染期患者14例，处于感染期患者9例，术后复发再手术者2例。手术时整块切除瘘管组织及瘢痕组织。观察分析手术标本并行连续病理切片。结果：①大体形态：有感染史非感染期的手术标本近端为瘘管组织，保持瘘管原有形态，中远端为暗红色实性瘢痕组织；处于感染期的手术标本近端为瘘管组织，远端为肉芽组织和瘢痕组织包绕形成的脓腔，瘘管与脓腔不相交通；术后复发的标本为多囊性肿物，呈典型的哑铃状外观。②组织学观察：有感染史非感染期者和术后复发者镜下可见瘘管远端走行不连续，呈多个束状管腔，管腔之间被条索状纤维组织分隔；处于感染期者镜下除上述表现外，脓腔周围可见新生的毛细血管及浆细胞、淋巴细胞和中性粒细胞浸润。③随访6～12个月，无复发。结论：感染性先天性耳前瘘管组织被瘢痕组织分隔为多段，互不相通，瘘管内注射美蓝等示踪剂无法完整显示瘘管的走行，故单纯依靠示踪剂切除瘘管易致残留。整块切除瘘管组织及瘢痕组织是防止瘘管上皮残留的有效手段，可降低术后复发率。To investigate the pathology characteristics of congenital preauricular fistula with infec- tion, in order to reduce the recurrence rate after surgery and improve operative technique. Method：Twenty-five pa- tients diagnosed as congenital preauricular fistula with infection were analyzed. There were 14 patients in infection history group, 9 in infective stage group,and 2 in recurrence group respectively. The whole piece of fistula and scar tissue was completely excised during operation. The specimens were observed by naked eye and serial tissue sec- tions were analyzed. Result： ①Macroscopically, in infection history group, initial morphology can be maintained near the fistula orifice,but the distal tissue was dark red scar tissue. In infective stage group, the distal tissue of the specimens was granulation tissue and cicatricial tissue. The g.ranulation tissue was crisp and bright red. In re- currence group, multicystic lesions with severe edema was observed,with a classical dumb-bell appearence. ②Mi- croscopically,in infection history group and recurrence group,we can see thatthe distal fistula tissue was discontin- uous and was separated by scar tissue. In infective stage group, we can find neo-angiogenesis and infiltration ofplas- ma cells,lymphocytes,neutrophil between interrupted fistula tissues. ③ All patients were followed up for 6- 12 month, without recurrence. Conclusion：The fistula tissue of congenital preauricular fistula with infection was divid- ed by the scar tissue ,and they did not communicate with each other. Complete delineation of fistula is hardly a- chieved by methylene blue staining. Radical excision of the fistula and scar tissue may help to avoid leaving viable squamous epithelial remnants and reduce the recurrence rate.

关 键 词：耳前瘘管 瘢痕 感染 病理学 外科手术 

分 类 号：R764[医药卫生—耳鼻咽喉科]