以面中部感染为首发症状的儿童鼻中线囊肿及瘘管59例临床分析  

Clinical analysis of 59cases of pediatric nasal dermal sinus cysts with midfacial infection as the first symptom

作　　者：杨小健[1] 唐力行[1] 王蓬鹏[1] 孙记航[2] 张薇 肖潇[1] 韩阳[1] 葛文彤[1] YANG Xiaojian;TANG Lixing;WANG Pengpeng;SUN Jihang;ZHANG Wei;XIAO Xiao;HAN Yang;GE Wentong(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing,100045,China;Department of Radiology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,National Center for Children's Health,Beijing,100045,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,北京100045 [2]国家儿童医学中心、首都医科大学附属北京儿童医院影像科,北京100045

出　　处：《临床耳鼻咽喉头颈外科杂志》2022年第11期849-854,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:总结以面中部感染为首发症状的儿童鼻中线囊肿及瘘管(NDSC)的临床特点及诊疗经验。方法:收集2007年1月—2021年12月就诊于北京儿童医院的59例NDSC继发额鼻眶区感染患儿的临床资料。均完善薄层CT及MRI检查,并进行全身麻醉内镜辅助下囊肿及瘘管切除术。结果:59例病例包括囊肿1例,瘘管58例。NDSC主要部位包括鼻根20例(33.9%),鼻梁34例(57.6%),鼻尖4例(6.8%),鼻尖及鼻根1例(1.7%)。病变深度包括鼻额骨浅表型6例(10.2%),鼻额骨型33例(55.9%),颅内硬膜外型19例(32.2%),颅内硬膜内型1例(1.7%)。感染灶主要部位包括内眦15例(25.4%),鼻背22例(37.3%),鼻根16例(27.1%),前额部6例(10.2%)。59例患儿中,合并其他疾病7例(11.9%),外鼻畸形4例(6.8%)。手术入路包括横行小切口12例(20.3%),纵行小切口41例(69.5%),开放式整形切口4例(6.8%),双顶冠状切口2例(3.4%)。病变范围与MRI结果均完全符合。所有患儿手术过程顺利,未行一期鼻背重建术。术后随访7~173个月(平均52.2个月),复发6例,均为鼻梁瘘管原位复发,再次手术,随访至今无复发。全部患儿外鼻无畸形,外观满意。结论:以面中部感染为首发症状的儿童NDSC感染临床少见,表现多样。早期诊断及合理化治疗对于提高治愈率至关重要。高分辨率MRI辅以CT扫描对于判断NDSC的走行,尤其是与颅内贯通情况具有重要意义。治疗目标是在彻底切除病灶的前提下尽量做到微创、个体化,并兼顾美容需求。Objective:To review the clinical and radiological presentation and management of infected nasal dermal sinus cysts(NDSC)in children.Methods:Clinical data were collected from 59 NDSC children with secondary fronto-orbital area infection who presented to Beijing Children’s Hospital from January 2007 to December 2021.All patients underwent preoperative imaging workup,including MRI and CT.All patients underwent endoscopic excision of a NDSC under general anesthesia.Results:A total of 59 patients were included in the study,while 58 presented with a sinus,1 presented with a cyst.The main lesions of NDSC included nasal root in 20 cases(33.9%),nasal bridge in 34 cases(57.6%),nasal tip in 4 cases(6.8%),and nasal tip and nasal root in 1 case(1.7%).The depth of lesions included 6 cases(10.2%)of superficial type of nasal frontal bone,33 cases(55.9%)of nasal frontal bone,19 cases(32.2%)of intracranial epidural type,and 1 case(1.7%)of intracranial epidural type.The main sites of infection included inner canthus in 15 cases(25.4%),nasal dorsum in 22 cases(37.3%),nasal root in 16 cases(27.1%),and forehead in 6 cases(10.2%).Among 59 cases,7 cases(11.9%)were complicated with other diseases,and 4 cases(6.8%)had external nasal deformities.Surgical approaches included transverse incision in 12 cases(20.3%),minimal midline vertical incision in 41 cases(69.5%),external rhinoplasty in 4 cases(6.8%)and bicoronal incision with vertical incision in 2 cases(3.4%).The range of lesions was completely consistent with MRI results.All cases were successfully operated without one-stage nasal dorsum reconstruction.All patients were followed up from 7 to 173 months(average 52.2 months).There were 6 cases of recurrence,all of which were in situ recurrence.The operation was performed again,and no recurrence has occurred since the follow-up,No nasal deformity was noted,and cosmetic outcome were favorable for all patients.Conclusion:NDSC infection in children with midfacial infection as the first symptom is rare in clinical practice,and its manifesta

关 键 词：儿童 鼻中线囊肿 瘘管 外科手术 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]