鳃裂囊肿瘘管临床分析

目的总结29例先天性鳃裂囊肿(瘘)病例资料,对其诊疗方法进行探讨。方法回顾性分析1999年9月～2009年12月手术治疗的29例鳃裂囊肿及瘘管的临床资料,包括术前检查、诊疗、术后病理诊断。结果术后病理均确诊为鳃裂囊肿或瘘管,B超诊断囊肿符合率最高为72.2%(13/18),40%碘油X线造影诊断瘘管符合率最高为63.6%(7/11),第一鳃裂囊肿(瘘)误诊率为54.5%(6/11),手术治疗29例,随访6个月～12年,2例复发,经扩大切除,随访至今未再复发。结论 B超对鳃裂囊肿诊断有较高的确诊率,而碘油X线造影对瘘管有较高的确诊率,第一鳃裂囊肿(瘘)易误诊,手术完整切除囊肿及瘘管是唯一根治方法     

先天性鳃裂囊肿及瘘管的外科治疗(附67例分析)

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2002年8月收治的67例患者的临床资料.其中男35例,女32例,5～73岁;其中11～30岁41例,占61.2%;左侧38例,右侧27例,双侧2例;单纯囊肿48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58例,占86.57%, 第一、第三鳃裂畸形分别为5例和4例.经随访,一期治愈59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.     

先天性第一鳃沟瘘管及囊肿10例

先天性第一鳃沟瘘管及囊肿即先天性耳颈瘘管及囊肿(congenital auriculocervical fistula and cyst)起源于第一鳃沟浅咽囊,外瘘口及绝大多数瘘管及囊肿的全程皆位于颈侧,故又称颈侧瘘管及囊肿,患者多以颈部、耳部瘘口流脓或颈部肿块就诊,本病以手术治疗为主,但易出现残留、复发     

鳃裂囊肿及瘘管诊断和治疗

目的探讨鳃裂囊肿及瘘管的诊断和治疗。方法分析1991～2003年收治的48例鳃裂囊肿及瘘管的临床资料。结果好发部位在第Ⅱ鳃裂,第Ⅰ、Ⅲ鳃裂也可发生;病史、发病部位、穿刺细胞学是诊断鳃裂囊肿及瘘管的主要因素,感染后粘连、病程长增加了手术难度,本组病例均经手术切除并经病理证实。结论鳃裂囊肿临床少见,对怀疑鳃裂囊肿的病例可行针吸穿刺细胞学、B超及CT检查,治疗以早期完整切除肿瘤为佳。术中注意保护面神经、迷走神经、颈动脉鞘等重要结构,为减少复发须注意瘘管的完整切除和内瘘口的处理。     

复发性先天性颈侧瘘管及囊肿治疗方式的回顾性分析

目的:总结39例复发性先天性颈侧瘘管及囊肿患者的治疗经验,以期提高颈侧瘘管及囊肿的治愈率。方法:回顾性分析39例手术切除后复发的颈侧瘘管及囊肿患者的诊治过程。其中第一鳃裂来源12例,第二鳃裂来源6例,第三鳃裂来源21例。结果:所有患者经历瘘管或囊肿切除手术2～5次。最后1次术后随访9个月～17年,6例失访;6例复发(第一鳃裂瘘管1例,第二鳃裂瘘管3例,第三鳃裂瘘管1例、囊肿1例);1例第一鳃裂瘘管患者第3次术后发生癌变,第4次术后1年死亡。2例第三鳃裂瘘管穿过甲状腺,术中切除瘘管穿行的甲状腺组织。所有术中找到明确内口并进行有效结扎的颈侧瘘管患者术后在随访期间均未见复发。结论:提高对颈侧鳃裂畸形的认识,合理选择手术时机,制定有效的手术方案是复发性颈侧瘘管治愈的关键。     

第一鳃裂囊肿及瘘管的手术治疗CSCD

第一鳃裂囊肿及瘘管临床较少见,手术较复杂,手术后易出现面瘫。我们采用显微镜下切除囊肿或瘘管上皮层的方法治疗第一鳃裂囊肿及瘘管,方法简单,效果满意。1.1临床资料。从2002年1月～2017年6月收治第一鳃裂囊肿及瘘管49例,男29例,女20例,年龄3～65岁,均为单侧发病,左侧28例,右侧21例,其中囊肿8例,瘘管41例,合并先天性外耳道狭窄12例。     

先天性颈侧第三鳃裂瘘管

先天性鳃裂瘘管和囊肿源自鳃沟或咽囊，外瘘口及大多数者的全程皆位于颈测部，故又称为颈侧瘘管或囊肿。鳃裂瘘管和囊肿临床上虽较多见，但绝大多数属于第二鳃裂囊肿和瘘管，而其他鳃沟咽囊的瘘管和囊肿则少见，特别是第３、４鳃沟咽囊瘘管和囊肿更是少见。我院曾收治３例第三鳃裂瘘管病例，均行手术治疗，并经手术和病理检查证实，现报告如下。例１女２２岁。自幼左颈部胸锁关节上方有一瘘口，经常红肿、疼痛、流脓。瘘口有粘脓性分泌物流出。检查：左胸锁乳突肌前缘下１／３交界处，有一绿豆大小瘘口及１．８ｃｍ×１．５ｃｍ的瘢痕，瘘口…     

鳃裂畸形40例

目的：分析鳃裂囊肿及瘘管的临床特点,探讨其诊断和治疗方法。方法：对40例鳃裂囊肿及瘘管患者的临床资料进行回顾性分析,并结合文献对诊断、鉴别诊断、治疗经验及教训进行探讨;全部患者均经手术切除囊肿及瘘管。结果：随诊1～5年,2例失访,36例无复发;2例复发,再次手术,分别随访42和14个月,未复发。结论：颈侧部沿胸锁乳突肌前缘自耳周腮腺区至锁骨上孤立的、无痛囊性包块,或有反复感染成颈部脓肿、破溃、多次切开引流者均应考虑鳃裂囊肿及瘘管。颈部B超、增强CT、MRI、碘油造影、钡餐检查、直接喉镜检查均可辅助诊断,病理检查可确诊。手术切除仍为治疗鳃裂畸形的主要方法。     

先天性第四鳃裂畸形的走行探讨和治疗经验

目的 对先天性第四鳃裂畸形的走行进行探讨并总结治疗经验.方法 回顾性分析2005年1月至2012年4月收治的12例第四鳃裂畸形患者的临床资料,对第四鳃裂畸形的走行及其手术方式进行分析.结果 12例患者术中均显露喉返神经,10例行甲状腺腺叶部分切除,其中2例行Ⅱ、Ⅲ、Ⅳ及Ⅵ区颈清扫术；此10例病变均行于甲状腺后方,其中7例进入梨状窝尖；1例术前检查示内瘘口于梨状窝尖,但术中未探及内瘘口；1例止于颈段食管侧壁；1例开口于颈段食管.另2例患者中1例病变以条索止于甲状腺外侧,1例为甲状腺外侧囊肿.本组无瘘管绕过舌下神经的病例,也没有延伸至纵隔的病例.1例患者术中切断左侧喉返神经,立即行喉返神经端端吻合术,术后左侧声带麻痹.本组患者术后随访8～88个月,中位随访时间24个月,10例无复发,1例复发,1例失访.结论 本组病例的先天性瘘管走行与理论走行不符合.病变大多与甲状腺和喉返神经关系密切,需保护喉返神经,处理甲状腺.对难以辨认瘘管走行的复发病例应行上至二腹肌下的Ⅱ、Ⅲ、Ⅳ及Ⅵ区颈清扫术.术中未找到内瘘口者,应进行长期随访.     

双耳前瘘管伴一侧鳃裂囊肿1例报告

先天性鳃裂瘘管或囊肿由胚胎时鳃裂残余发展形成,第一鳃裂瘘管或囊肿是由第一鳃沟发育异常所致,临床少见,Ａｒｎｏｔ（１９７１年）将此病分两型, Ｉ型外孔位于耳前或耳后,瘘道与外耳道平行,但不通外耳道内,故囊肿、窦道多在面神经外上方,现将遇到一例双耳前瘘管伴右侧第一鳃裂囊肿病人,报告如下。 患者,男性,１８岁,因双耳前反复肿痛十余年,加重一周入院,患者幼年即出现双耳前肿痛反复发作以右侧较甚。一直拟“双耳前瘘管”保守治疗。一周前症状复发,门诊予补液抗炎及切开排脓治疗后收住入院,检查：双耳廓正常,耳屏前上方…     

First branchial cleft fistula presenting with external opening on earlobe

First branchial cleft fistula is a rare congenital malformation of the head and neck with an incidence of less than 10% of all branchial cleft defects. We herein report a 15-year-old girl who had a cystic mass in the postauricular region with an external opening on the posterior face of the earlobe. Surgical exploration revealed that a second sinus tract was passing through the conchal cartilage without going beyond the skin of the external acoustic meatus. The mass and the tract were excised along with the opening on the earlobe as well as the skin island surrounding the opening. The case was treated surgically with success .The significance of our case was the location of external opening on the earlobe.     

31例鳃裂发育畸形临床诊治分析

目的探讨鳃裂发育畸形的临床诊治。方法回顾性分析31例鳃裂瘘管、窦道及囊肿诊治情况,其中第一鳃裂瘘管7例,第二鳃裂瘘管6例、鳃裂窦道及囊肿12例,第三鳃裂瘘管6例。初次手术者16例,复发再次手术者15例。结果经合理用药,术中熟悉瘘管行走途径,精细解剖,彻底切除瘘管、窦道及囊肿,1例出现面神经下颌缘支不全麻痹;1例出现咽瘘,经换药后痊愈。其中27例随访1年以上,截止目前无1例再次复发。结论熟悉各型鳃裂畸形的发病机制及颈部解剖,合理选择手术时机是治愈该种疾病的关键。     

74例鳃裂囊肿及瘘管临床分析

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。     

87例鳃裂畸形临床特征分析

目的 总结鳃裂畸形患者的临床特点,探讨其临床诊疗方案。方法 收集2000年1月—2022年9月确诊为鳃裂畸形的87例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,第一鳃裂畸形患者10例,第二鳃裂畸形患者52例,第三鳃裂畸形患者20例,第四鳃裂畸形患者5例。15例患者有过相关颈部手术史。所有患者均采取手术治疗,仅1例出现暂时性面神经麻痹,术后3个月恢复。随访6个月至16年,81例患者完成术后随访。6例患者术后出现复发,再次行颈部肿物切除术+等离子梨状窝瘘口封闭术,随访7~8年均未再复发。结论 先天性鳃裂畸形诊断较为困难且相对容易复发,术前结合多种检查可提高诊断准确性,手术彻底切除病灶是首选治疗方案,急性感染期患者先予以颈部清创,待稳定期再行手术切除可以降低术后复发率。     

先天性第一鳃裂瘘14例报告

目的总结14例先天性第一鳃裂瘘的诊治经验，提高手术切除第一鳃裂瘘的安全性和治愈率。方法对1986年9月-2005年10月本科收治的14例第一鳃裂瘘的临床资料进行回顾性分析，选择适当的瘘管示踪方式探查其走行，作Y形切口，切除或外翻腮腺浅叶，先找出面神经主干，再分离瘘管，处理内口时切除部分外耳道软骨。结果14例均一次手术治愈，随防1—19年，失访2例，其余无复发。结论术前明确诊断，充分暴露面神经干，完整切除瘘管是手术成功的关键。     

Malformations of the first branchial cleft: duplication of the external auditory canal

OBJECTIVE: Malformations of the first branchial cleft are uncommon and only sporadic reported in the literature. The may be present as a swelling or inflammatory opening on the neck, blind cysts or fistula associated with the external auditory canal. In this retrospective study, clinical features, diagnostic and therapeutic pitfalls are described in nine pediatric cases. PATIENTS AND RESULTS: Between 1998 and 2002, duplication of the external auditory canal were diagnosed in nine patients aged from 7 months to 14 years. Three infants had cysts in the external ear canal; one had a sinus on the anteroinferior canal wall. One girl had two canals divided by skin and both were blind ended. Three children had clinically swelling or abscess formation with persistent drainage below the earlobe or on the neck and one girl had swelling behind the auricle. All patients were treated surgically. CONCLUSION: The first branchial cleft malformation may be unrecognized or may be mistaken for tumors or other inflammatory lesions in the periauricular region. Surgical treatment might then be inadequate leading to recurrence or secondary infection. The distinct clinical features, which can be derived from embryologic development, usually lead to the correct diagnosis and favorable surgical treatment.     

An unusual presentation of branchial cleft fistula penetrating the submandibular gland

First branchial cleft anomalies constitute a rare entity with variable clinical presentations and anatomic findings. We describe a 14-month-old girl with a congenital cutaneous fistula running from a cutaneous opening in the left submandibular triangle through the submandibular gland and ending in the pharyngeal cavity. These features suggested type II first branchial cleft fistula with an extremely unusual path. Complete excision resulted in successful treatment without recurrence. Since the first branchial cleft fistula can originate anywhere along the salivary gland and can extend from this area, surgeons should maintain a high index of suspicion for anatomic variants of this rare condition.     

Cystic metastasis versus branchial cleft carcinoma: a diagnostic challenge

OBJECTIVES: There is controversy regarding the existence of branchial cleft carcinomas. The objectives are to familiarize the clinician with the presentation and treatment of cystic metastases from head and neck primary sites and differentiate these from primary branchial cleft cyst carcinomas. STUDY DESIGN: Retrospective case study and literature review. METHODS: Published reports of branchial cleft carcinomas were reviewed in conjunction with a unique case presenting at the University of Texas Medical Branch (Galveston, TX). RESULTS: Most cases of branchial cleft carcinomas are probably cystic metastases from head and neck primary sites. Cutaneous involvement with primary branchial cleft carcinomas is rare but may occur in recurrent lesions. CONCLUSIONS: The diagnosis of a primary branchial cleft cyst carcinoma requires the fulfillment of strict criteria. Cystic metastases from head and neck primaries can mimic branchial cleft carcinomas histologically. Correct diagnosis is important so that appropriate surgical and radiotherapeutic treatment can be delivered.     

第一鳃裂瘘管切除术中面神经解剖的临床意义

目的探讨面神经解剖在第一鳃裂瘘管切除术中的意义。方法回顾性分析我科2005～2010年收治的23例第一鳃裂瘘管患者的临床资料。所有病例均在明视面神经的情况下完整切除病变及周围瘢痕组织。10例无手术史的患者行面神经总干解剖法;13例有术前切开引流及瘘管切除史的患者行面神经下颌缘支解剖法。结果所有患者手术切口均I期愈合。1例患者术后出现一过性面瘫,术后1周时完全恢复。5例行外耳道部分皮肤和软骨切除的患者术后均无外耳道狭窄及听力下降。随访9个月～6年,23例患者均未见复发。结论第一鳃裂瘘管与面神经关系密切,面神经解剖在第一鳃裂瘘管切除术中可有效防止面神经不可逆损伤。     

Branchial anomalies in children

Background

Branchial cleft anomalies are the second most common head and neck congenital lesions seen in children. Amongst the branchial cleft malformations, second cleft lesions account for 95% of the branchial anomalies. This article analyzes all the cases of branchial cleft anomalies operated on at Great Ormond Street Hospital over the past 10 years.

Methods

All children who underwent surgery for branchial cleft sinus or fistula from January 2000 to December 2010 were included in this study.

Results

In this series, we had 80 patients (38 female and 42 male). The age at the time of operation varied from 1 year to 14 years. Amongst this group, 15 patients had first branchial cleft anomaly, 62 had second branchial cleft anomaly and 3 had fourth branchial pouch anomaly. All the first cleft cases were operated on by a superficial parotidectomy approach with facial nerve identification. Complete excision was achieved in all these first cleft cases. In this series of first cleft anomalies, we had one complication (temporary marginal mandibular nerve weakness. In the 62 children with second branchial cleft anomalies, 50 were unilateral and 12 were bilateral. In the vast majority, the tract extended through the carotid bifurcation and extended up to pharyngeal constrictor muscles. Majority of these cases were operated on through an elliptical incision around the external opening. Complete excision was achieved in all second cleft cases except one who required a repeat excision. In this subgroup, we had two complications one patient developed a seroma and one had incomplete excision. The three patients with fourth pouch anomaly were treated with endoscopic assisted monopolar diathermy to the sinus opening with good outcome.

Conclusion

Branchial anomalies are relatively common in children. There are three distinct types, first cleft, second cleft and fourth pouch anomaly. Correct diagnosis is essential to avoid inadequate surgery and multiple procedures. The surgical approach needs to be tailored to the type of anomaly of origin of the anomaly. Complete excision is essential for good outcomes.