先天性鳃裂囊肿及瘘管的外科治疗(附67例分析)  

The surgical treatment of the congenital branchial cleft cyst and fistula: with an analysis of 67 cases

作　　者：黄方[1] 吴瑞珊[1] 

机构地区：[1]福建医科大学附属二院耳鼻咽喉科,福建泉州362000

出　　处：《山东大学基础医学院学报》2003年第3期129-131,共3页Journal of Preclinical Medicine College of Shandong Medical University

摘　　要：目的 :探讨先天性鳃裂囊肿及瘘管的诊断和治疗方法。方法 :回顾分析 1984至 2 0 0 2年 8月收治的6 7例患者的临床资料。其中男 35例 ,女 32例 ,5～ 73岁 ;其中 11～ 30岁 4 1例 ,占 6 1.2 % ;左侧 38例 ,右侧 2 7例 ,双侧 2例 ;单纯囊肿 4 8例 ,囊肿合并瘘管 3例 ,单纯瘘管 16例 ;合并其它鳃器畸形 3例 :先天性耳前瘘管3例次 ,先天性小耳、外耳道闭锁及先天性面瘫 1例 ;囊肿恶变 2例 ,其中 1例为异时性双原发癌 (鳃裂癌术后3年出现下咽癌 )。结果 :所有病例均经手术治疗 ,第二鳃裂畸形 5 8例 ,占 86 .5 7% ,第一、第三鳃裂畸形分别为 5例和 4例。经随访 ,一期治愈 5 9例 ,复发再次手术治愈 8例。结论 :影像学检查及术前针吸活检是术前确诊的重要依据 ;食管稀钡造影或囊肿碘油造影有助于囊肿及内瘘口定位 ,术前少量多次吞服稀释美蓝溶液 ,有助于术中寻找瘘管及内瘘口。完整切除囊肿及瘘管是避免复发的重要措施 ,寻找内瘘口并予以荷包缝扎 ,使瘘管口上皮层朝向咽腔是手术成功的关键。Objective:To explore the diagnosis and treatment for the congenital branchial cleft cyst and fistula. Method: The clinical material of 67 patients with branchial cleft cyst and fistula were analyzed.There were branchial cleft cyst in 48 cases ,branchial fistula in 16 cases, and both in 3 cases;branchial carcinoma in 2 cases, other organ deformity in 3 cases. Result:All patients were cured by surgical recision, of them, first branchial cleft deformity was in 5 cases, second branchial deformity in 58 cases(86.57%), third in 4 cases. Followed up from 1.5 months to 4 years, 59 cases were cured, 8 cases recurred and were well treated once again. Consulsion: CT, MRI,ultrasound, barium esophagography, and fine neddle aspiration biopsy(FNAB) can be used in search of the fistulous tract and its internal open.Complete surgical resection including the cyst and fistulous tract down to the pyriform sinus is impoutant to avoid recurrence.

关 键 词：先天性鳃裂囊肿 先天性瘘管 外科治疗 诊断 影像学检查 针吸活检 

分 类 号：R782.2[医药卫生—口腔医学]