乳突径路定位茎乳孔面神经后切除复杂性第一鳃裂瘘管或囊肿临床研究  

The study on effective surgical approach to resect complex first branchial fistula or cyst

作　　者：陈伟章 李伟[1] 戴春富[1] CHEN Weizhang;LI Wei;DAI Chunfu(Ear Clinic Center of Eye,Ear,Nose and Throat Hospital Affiliated to Fudan University,Key Laboratory of Hearing Research,National Health Commission,Shanghai,200031,China;Department of Otolaryngology,Meizhou People's Hospital,Meizhou,Guangdong,514000,China)

机构地区：[1]复旦大学附属眼耳鼻喉医院耳科中心,国家卫健委听觉医学重点实验室,上海200031 [2]梅州市人民医院耳鼻咽喉科,广东梅州514000

出　　处：《中国耳鼻咽喉头颈外科》2023年第5期292-295,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的 探讨复杂性第一鳃裂瘘管或囊肿手术切除的有效径路。方法 回顾性分析2010年1月-2021年8月复旦大学附属眼耳鼻喉医院收治的13例复杂性第一鳃裂瘘管或囊肿患者,所有患者均在显微镜下采用乳突完壁切除,开放茎乳孔并定位面神经,随后解剖腮腺面神经总干,在保护面神经及保留腮腺解剖结构前提下行第一鳃裂瘘管或囊肿切除。结果 本研究中男4例,女9例,年龄7-68岁,病史10-420个月不等,既往手术切除史8例,反复切开引流病史5例。随访时间4个月-11年。术前颞骨MRI T2WI平扫示病变为高信号,同面神经解剖关系密切。所有患者病变完全切除,1例患者切口感染,其余病例切口均Ⅰ期愈合,术后3个月面神经H-B I级,纯音测听示手术耳平均听阈,气导听阈16 d B,骨导听阈8 d B。所有患者无外耳道狭窄,无涎瘘、口干及Frey综合征发生;2例患者术后短暂出现唇角歪斜,H-B II级,经治疗随访2个月后面瘫恢复,术后颞骨MRI平扫示瘘管已被切除,13例患者均未见复发。结论 复杂性第一鳃裂瘘管或囊肿与面神经的解剖关系密切,显微镜下乳突完壁式切除后能定位茎乳孔面神经,随后能快速,准确解剖腮腺面神经总干,有效切除瘘管或囊肿,避免损伤面神经。OBJECTIVE To explore an effective surgical approach to resect complex first branchial fistula or cyst.METHODS Thirteen patients with complex first branchial fistula or cyst have been treated in the Eye,Ear,Nose and Throat Hospital Affiliated to Fudan University from January 2010 to August 2021.Under the microscope,mastoidectomy with canal wall up was conducted,the facial nerve at the styloid mastoid foramen was identified,further dissection of facial nerve main trunk in the parotid gland was performed,and the first branchial fistula or cyst were removed while the intact anatomy of facial nerve and parotid gland were preserved.There were 4 males and 9 females whose ages ranged from 7 to 68.The duration of medical history ranged from 10 to 420 months.There were 8 cases with previous surgical history and 5 cases with multiple incisions and drainages due to infection.The follow-up duration ranged from 4 months to 11 years.RESULTS Preoperative temporal bone MRI T2WI demonstrated high signal lesions which were intimated with the facial nerve in the parotid gland.Postoperative temporal bone MRI T2WI revealed no residual lesion in the parotid gland.All patients recovered from the first branchial fistula or cyst without recurrence.No patient complained of facial nerve palsy,hearing loss,stenosis of external auditory canal,salivary fistula,dry mouth and Frey's syndrome in the last follow-up.Temporary facial palsy was noted in 2 patients with H-B II.CONCLUSION Intimated anatomical relationship between the first branchial fistula or cyst and the facial nerve was present in patients with complex first branchial fistula or cyst.The facial nerve at the styloid mastoid foramen was able to identified following mastoidectomy with canal wall up,further dissection of the facial nerve in parotid gland was conducted,then removal of the fistula or cyst was completed without damage of the facial nerve.

关 键 词：鳃区 瘘 囊肿 面神经(Ⅶ) 手术后并发症 复杂性第一鳃裂瘘管或囊肿 手术入路 

分 类 号：R651.3[医药卫生—外科学]