山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (4): 111-116.doi: 10.6040/j.issn.1673-3770.0.2019.523

• 论著 • 上一篇    下一篇

74例鳃裂囊肿及瘘管临床分析

王莹莹,张立庆,周涵,董诗坤,陈海兵,陈曦,董伟达   

  1. 王莹莹, 张立庆, 周涵, 董诗坤, 陈海兵, 陈曦, 董伟达南京医科大学第一附属医院/江苏省人民医院 耳鼻咽喉科, 江苏 南京 210029
  • 收稿日期:2019-10-17 出版日期:2020-07-20 发布日期:2020-08-28
  • 作者简介:王莹莹. E-mail: 2471589893@qq.com
  • 基金资助:
    江苏省卫生计生委面上课题(H201603);江苏省青年医学人才项目(QNRC2016614)

Clinical analysis of 74 cases of branchial cleft cysts and fistulasWANG Yingying, ZHANG Liqing, ZHOU Han, DONG Shikun, CHEN Haibing, CHEN Xi, DONG Weida Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu, ChinaAbstract:Objective〓

This study aimed to describe the clinical features of 74 patients with cleft palate cysts and fistulas and analyze the diagnosis and treatment methods. MethodsBetween January 2010 and September 2019, the clinical data of 74 patients with branchial cleft cysts and fistulas were retrospectively reviewed and analyzed with related literature in our department. ResultsOf the 74 patients, 50 patients were diagnosed with second branchial cleft anomalies, 13 patients had first branchial cleft lesions, 10 patients had third branchial cleft lesions, and one patient had a fourth branchial cleft lesion. All patients received surgical treatment. After the exclusion of 3 patients who were lost to follow-up, 67 patients were successfully treated, 3 patients reported relapse, and 1 had permanent facial paralysis. ConclusionsThe clinical manifestations of congenital cleft palate cysts and fistulas are diverse, and the differential diagnosis is complicated. It is essential to perform a detailed physical examination and preoperative evaluation to make an accurate diagnosis. The approach for management is individualized, and surgical rehabilitation is the preferred treatment.   

  1. Key words: Branchial cleft cysts;
    Branchial fistula;
    Preoperative examination;
    Surgical treatment鳃裂异常是一种常见的先天性畸形, 术语鳃裂囊肿首先由Ascherson[1]于1832年使用。鳃裂异常是儿童期第二常见的头颈部先天性病变, 占儿童头颈肿块的20%[2], 成年患者也不少见, 主要表现为囊肿、瘘管和窦道[3]。鳃裂病变种类较多且表现各异, 诊断并不容易, 而且若鳃裂病变并发感染, 形态及临床表现往往不典型, 鉴别诊断则更加困难, 从而导致了临床上较高的误诊漏诊率。该病灶毗邻关系复杂, 术中可能会存在瘘管残留的情况, 后续反复复发感染也会给患者生理及心理造成影响, 是耳鼻咽喉头颈外科医师面临的难题之一。为了提高对本病的认识, 我们总结分析了近10年在我院就诊鳃裂囊肿及瘘管患者的临床资料, 现报道如下。
  • Received:2019-10-17 Online:2020-07-20 Published:2020-08-28

摘要: 目的 总结74例鳃裂囊肿及瘘管的临床特点,探讨其诊疗方法。 方法 收集2010年1月至2019年9月收治的74例鳃裂囊肿和鳃裂瘘患者的临床资料并结合文献进行回顾性分析。 结果 本组患者中有50例为第二鳃裂病变,13例为第一鳃裂病变,10例为第三鳃裂病变,1例为第四鳃裂病变,于我院初次手术时术前误诊率为10.81%。所有患者均采取手术治疗,随访3个月~10年。除3例失访患者外,67例患者一次性治愈,3例患者术后复发,1例患者术后出现永久性面神经麻痹。 结论 先天性鳃裂囊肿及瘘管临床表现多样,鉴别诊断较为复杂,应合理选用多种检查手段,术前准确评估,制定个体化的手术方案彻底切除病灶是首选治疗方法。

关键词: 鳃裂囊肿, 鳃裂瘘, 术前检查, 手术治疗

Abstract: Objective This study aimed to describe the clinical features of 74 patients with cleft palate cysts and fistulas and analyze the diagnosis and treatment methods. Methods Between January 2010 and September 2019, the clinical data of 74 patients with branchial cleft cysts and fistulas were retrospectively reviewed and analyzed with related literature in our department. Results Of the 74 patients, 50 patients were diagnosed with second branchial cleft anomalies, 13 patients had first branchial cleft lesions, 10 patients had third branchial cleft lesions, and one patient had a fourth branchial cleft lesion. All patients received surgical treatment. After the exclusion of 3 patients who were lost to follow-up, 67 patients were successfully treated, 3 patients reported relapse, and 1 had permanent facial paralysis. Conclusions The clinical manifestations of congenital cleft palate cysts and fistulas are diverse, and the differential diagnosis is complicated. It is essential to perform a detailed physical examination and preoperative evaluation to make an accurate diagnosis. The approach for management is individualized, and surgical rehabilitation is the preferred treatment.

Key words: Branchial cleft cysts, Branchial fistula, Preoperative examination, Surgical treatment

中图分类号: 

  • R739
[1] Meng F, Zhu Z, Ord RA, et al. A unique location of branchial cleft cyst: case report and review of the literature[J]. Int J Oral Maxillofac Surg,2019, 48(6): 712-715. doi:10.1016/j.ijom.2018.11.014.
[2] Teo NW,Ibrahim SI, Tan KK. Distribution of branchial anomalies in a paediatric Asian population[J]. Singapore Med J, 2015, 56(4): 203-207. doi:10.11622/smedj.2015060.
[3] Magdy EA, Ashram YA. First branchial cleft anomalies: presentation, variability and safe surgical management[J]. Eur Arch Otorhinolaryngol, 2013, 270(6): 1917-1925. doi:10.1007/s00405-012-2287-x.
[4] 陈晓红. 三维内镜下腮裂囊肿切除1例[J]. 中国医学文摘(耳鼻咽喉科学), 2014, 29(4): 229-231. doi:10.19617/j.issn1001-1307.2014.04.014.
[5] Zaifullah S, Yunus MR, See GB. Diagnosis and treatment of branchial cleft anomalies in UKMMC: a 10-year retrospective study[J]. Eur Arch Otorhinolaryngol, 2013, 270(4): 1501-1506. doi:10.1007/s00405-012-2200-7.
[6] Ballivet de Régloix S, Maurin O, Crambert A, et al. Congenital cysts and fistulas on the neck in adults[J]. Presse Med, 2019, 48(1 Pt 1): 29-33. doi:10.1016/j.lpm.2018.09.019.
[7] 张贝,陈良嗣,黄舒玲,等. Work Ⅱ型先天性第一鳃裂畸形与面神经解剖关系研究及外科策略[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(10): 760-765. doi: 10.3760/cma.j.issn.1673-0860.2017.10.009. ZHANG Bei, CHEN Liangsi, HUANG Shuling, et al. Relationship between Work Ⅱ type of congenital first branchial cleft anomaly and facial nerve and surgical strategies[J]. Chinese JOurnal of Otorhinolaryngology Head and Neck Surgery, 2017, 52(10): 760-765. doi: 10.3760/cma.j.issn.1673-0860.2017.10.009.
[8] Nicoucar K, Giger R, Pope HG Jr, et al. Management of congenital fourth branchial arch anomalies: a review and analysis of published cases[J]. J Pediatr Surg, 2009, 44(7): 1432-1439. doi:10.1016/j.jpedsurg.2008.12.001.
[9] Spinelli C, Rossi L, Strambi S, et al. Branchial cleft and pouch anomalies in childhood: a report of 50 surgical cases[J]. J Endocrinol Invest, 2016, 39(5): 529-535. doi:10.1007/s40618-015-0390-8.
[10] 马静, 明澄, 娄凡, 等. 儿童先天性梨状窝瘘的误诊原因分析及治疗方法探讨[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(5): 381-384. doi:10.3760/cma.j.issn.1673-0860.2018.05.010. MA Jing, MING Cheng, LOU Fan, et al. Misdiagnosic analysis and treatment of pyriform sinus fistula in children[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2018, 53(5): 381-384. doi:10.3760/cma.j.issn.1673-0860.2018.05.010.
[11] Oh JH, Chang YW, Lee EJ. Sonographic diagnosis of coexisting ectopic thyroid and fourth branchial cleft cyst[J]. J Clin Ultrasound, 2018, 46(9): 582-584. doi:10.1002/jcu.22630.
[12] Pal I, Kumar S, Mukherjee A, et al. Fourth branchial pouch sinus: a report of 7 cases and review of the literature[J]. Ear Nose Throat J, 2018, 97(8): 236-242. doi:10.1177/014556131809700820.
[13] 钟贞,赵恩民,刘玉和, 等. 先天性第四鳃裂畸形的走行探讨和治疗经验[J]. 中华耳鼻咽喉头颈外科杂志,2013. 48(7): 592-595. doi: 10.3760/cma.j.issn.1673-0860.2013.07.015. ZHONG Zhen, ZHAO Enmin, LIU Yuhe, et al. Fourth branchial abnormity and management experiences[J]. Chinese JOurnal of Otorhinolaryngology Head and Neck Surgery, 2013. 48(7): 592-595. doi: 10.3760/cma.j.issn.1673-0860.2013.07.015.
[14] Payne C, Gigliotti MJ, Castellvi A, et al. Rare case of cystic hygroma in the epidural space resulting in multilevel spinal cord compression[J]. BMJ Case Rep, 2019, 12(8): e230326. doi:10.1136/bcr-2019-230326.
[15] 管杰, 刘大昱. 颈部囊性水瘤的诊断与治疗进展[J]. 山东大学耳鼻喉眼学报, 2009, 23(6): 24-28.
[16] Ito K, Aoyama T, Miyaoka Y, et al. Surgical strategies for cervical spinal neurinomas[J]. Neurol Med Chir(Tokyo), 2015, 55(7): 557-563. doi:10.2176/nmc.ra.2014-0421.
[17] 蓝云英, 阳宇, 李鸿. 鳃裂癌一例报告并文献复习[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 112-114. doi:10.6040/j.issn.1673-3770.0.2017.417. LAN Yunying, YANG Yu, LI Hong. A report of 1 case of branchial fissure carcinoma and literature review[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(3): 112-114. doi:10.6040/j.issn.1673-3770.0.2017.417.
[18] Ha EJ, Baek SM, Baek JH, et al. Efficacy and safety of ethanol ablation for branchial cleft cysts[J]. AJNR Am J Neuroradiol, 2017, 38(12): 2351-2356. doi:10.3174/ajnr.A5373.
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