多层螺旋CT联合瘘管造影对先天性颈部瘘管的诊治价值  

Diagnostic value of multi-slice spiral computerized tomographic fistulography in congenital fistula of neck

作　　者：郑昊[1] 叶青[3] 王晓燕[1] 郑晓红[2] 杨心青[1] 陈勇[1] 蒋刈[1] 李瑞玉[1] 

机构地区：[1]福建医科大学省立临床医学院,福建省立医院耳鼻咽喉头颈外科,福州350001 [2]福建医科大学省立临床医学院放射科,福州350001 [3]福建省立医院北院、福建省老年医院耳鼻咽喉头颈外科,福州350009

出　　处：《中华耳鼻咽喉头颈外科杂志》2017年第8期597-603,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：福建省临床重点专科建设项目（闽卫医政[2015]593号）

摘　　要：目的 探讨多层螺旋CT联合瘘管造影（multi-slice spiral computerized tomographic fistulography,MSCTF）对先天性颈部瘘管的诊治价值.方法 回顾性分析2008年7月至2015年8月间收住院并经手术和病理证实的34例先天性颈部瘘管患者的临床资料：其中男13例,女21例,年龄3~46岁,中位数年龄37岁;甲状舌管瘘6例,第一鳃裂瘘9例,第二鳃裂瘘3例,第三鳃裂瘘9例,第四鳃裂瘘7例.34例术前均行MSCTF检查,原始图像在图像工作站AW Volume Share 4.2上进行多平面重建、最大密度投影及容积再现等处理,观察瘘管的类型、走行及其与周围组织间的关系,以此为据制订手术方案.结果 32例患者MSCTF显影良好,2例显影不全;依据MSCTF结果制订手术方案,术中在相应区域寻找瘘管,解剖重要血管、神经,全部病例均寻得并全切瘘管,3例行择区颈清扫术.术后1例出现切口感染,经换药后痊愈,1例出现患侧声带麻痹,随访3个月后恢复正常,其余病例未见明显手术并发症.术后1例失访,余33例随访13~97个月,未见瘘管复发.结论 MSCTF是术前评估先天性颈部瘘管的有效方法,对指导手术、定位瘘管有重要价值.Objective To investigate the usefulness and effectiveness of multi-slice spiral computerized tomographic fistulography （MSCTF） in the diagnosis and treatment of congenital fistula of neck.Methods Thirty-four patients with thyroglossal fistulasor branchial cleft fistulas who were initial treated from July 2008 to August 2015 in Fujian Provincial Hospital were retrospectively analyses.Thirteen males and 21 females patients aging from 3 to 46 years old with a median age of 37 were included.There were thyroglossal fistula in 6 cases, the first branchialcleft fistula in 9 cases, the second branchialcleft fistula in 3 cases, the third branchialcleft fistula in 9 cases, and the fourth branchialcleft fistula in 7 cases.All the patients underwent preopeative MSCTF and the diagnoses were finally confirmed with surgery and histopathology.Multiplanar reconstruction（MPR）,maximumintensity projection（MIP）and volume rendering（VR） were completed with AW Volume Share 4.2 image processing software after initial CT scanning.The internal openings,distribution, and neighboring relationship of the fistulas showed by MSCTF were analyzed and the surgical strategies were subsequently made.Results Except 2 cases, 32 patients had obtained successfully MSCTF image.The presence and location of the fistulas could be showed clearly on MSCTF.Based on the results of MSCTF examination, the surgical planes to treat the fistulas were made.The fistulas in all cases were successfully found and excised.Three cases underwent selective neck dissection.Postoperative infection occurred in 1 case.Unilateral vocal fold paralysis due to surgery recovered 3 months after surgery with follow-up.One case lost follow-up, the remaining 33 cases were followed up for 13-97 months with no the fistula recurrence.Conclusions MSCTF could provide valuable information and benefit surgical planning by demonstrating the coursesof congenital fistulas of neck in detail.

关 键 词：体层摄影术 X线计算机 瘘 甲状舌管囊肿 鳃区 先天畸形 

分 类 号：R762[医药卫生—耳鼻咽喉科]