第一鳃裂囊肿及瘘管的诊断治疗

目的 探讨先天性第一鳃裂囊肿及瘘管的诊断和治疗方法。方法 回顾性分析18例患者的病例资料,全部病例行手术切除。结果 18例患者中,第一鳃裂瘘 10例,外瘘口均位于耳垂后与乳突之间,内瘘口位于外耳道,其中位于骨与软骨交界处后下壁6例;囊肿8例,其中耳垂后4例,位于下颌角2例,腮腺筋膜内2例。术后病理均确诊为鳃裂囊肿或瘘管,随访未见复发。结论 先天性第一鳃裂囊肿及瘘管临床少见,易误诊、误治;影像学检查是术前确诊的重要依据;合理的手术方案是该病治愈的关键,完整切除囊肿及瘘管是避免复发的重要措施。     

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     

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。     

颈部囊肿与瘘管的诊断和治疗

目的总结颈部囊肿与瘘管的诊治经验.方法93例行手术治疗,其中鳃裂囊肿15例,鳃裂瘘管10例,皮样囊肿1例,囊状淋巴管瘤4例,甲状舌骨囊肿37例,甲状舌管瘘管25例,癌性淋巴液囊肿1例,随访1～10年.结果93例中,囊性淋巴管瘤1例复发后失访,另1例行2次手术,癌性淋巴液囊肿1例半年后死于肺转移,鳃裂瘘管2例3次手术,甲状舌管瘘管1例复发,鳃裂瘘管术后1例迟发性面瘫,一次手术治愈,无术后并发症.结论颈部囊肿与瘘管的诊断除依据术前检查外,主要是依据术中的发现和术后病理检查.B超、CT等是有效的辅助检查手段.治疗上应彻底切除囊壁与瘘管,避免复发.术中应避免损伤颈部的大血管和神经.甲状舌管瘘管须切除舌骨中段2cm,这是防止术后复发的关键.     

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。     

28例鳃裂囊肿及瘘管的诊治分析(摘要)

1990年 3月至 1996年 12月收治鳃裂囊肿及瘘管病人 2 8例 ,其中男 13例 ,女 15例 ;年龄 6～ 5 7岁 ,平均年龄为 2 4岁 ;病变大小在 1.0 cm× 1.0 cm× 1.2 cm～ 10 .0 cm× 8.0 cm× 6 .5 cm之间 ;发病时间 1周～ 30年 ;左颈 18例 ,右颈 10例。术前行针吸细胞学检查 2 2例 ,诊断为鳃裂囊肿 7例 ,鳃裂囊肿伴感染 10例 ,囊肿 1例 ,表皮性囊肿伴感染 3例 ,脓液 1例。颈部鳃裂囊肿伴感染有症状者 15例 ;术前造影 3例。治疗方法 :均采用手术切除。囊肿切除或摘除术 2 1例 ,囊肿加颈前瘘管切除术 5例 ,颈部肿物探查加大部分切除术 1例 ,肿物 (脓肿…     

颈部血管滤泡淋巴组织增生病的诊断与治疗

目的探讨颈部血管滤泡淋巴组织增生病（Castleman disease,CD）的临床表现及诊治。方法回顾性分析我院收治的2例颈部CD患者的临床资料,分析其临床表现、临床及病理分型、影像学特征和治疗方案。结果2例颈部CD发病年龄分别为24岁和29岁,均以单发无痛性颈部肿块就诊,无其他特殊临床症状。临床分型符合局限型CD,病理分型均符合透明血管型CD。2例颈部肿块均完整手术切除,分别随访1年和半年无复发。结论颈部CD常为局限性病变,以单发无痛性肿块缓慢增大为主要表现,常无其他特殊临床症状。常见发病部位为颈部淋巴结,病理分型几乎全部为透明血管型。完整肿块切除是治疗颈部CD的最佳治疗方法。     

第三鳃裂瘘管7例诊治体会

目的 探讨第三鳃裂瘘管有效的诊断和治疗方法.方法 回顾性分析2007年1月～2011年12月我院及安徽医科大学第一附属医院耳鼻咽喉科经手术及病理确诊的7例第三鳃裂瘘管患者的临床资料,探讨第三鳃裂瘘管的诊断及手术方法,总结临床经验.结果 7例患者中2例无手术史,5例有2～5次手术史,7例患者根据患者的颈部体征、纤维喉镜检查和影像学检查于术前能确定为第三鳃裂瘘管的有5例,2例行择区性颈清扫术于术中发现瘘管并根据瘘管内口确定为第三鳃裂瘘管,所有病例切口均一期愈合,无并发症.随访3月～5年,无1例复发.结论 对于腮裂瘘管应在术前采取多种检查方法以明确其类型有助于提高治愈率,除了碘油造影,下咽稀钡摄片外CT检查对感染期的第三腮裂瘘管具有较高的诊断价值;对于多次手术导致的术前难以确定腮裂瘘管类型的患者行择区性颈清扫术是较好的选择.     

第三腮裂瘘管诊治6例并文献复习

目的 探讨第三腮裂瘘管的临床特征及治疗方法。 方法 回顾性分析6例第三腮裂瘘管患者的临床资料,包括术前检查、手术治疗过程及疗效,并复习相关文献。行多层螺旋CT及瘘管碘造影剂造影,能显示瘘管走行及内瘘口位于梨状窝,全麻下应用功能性颈清扫术式彻底切除瘘管,术后切口一期愈合。 结果 6例中误诊3例,包括颈部脓肿2例、亚急性甲状腺炎1例。随访10个月以上无复发。 结论 多层螺旋CT及瘘管碘造影剂造影可显示瘘管全程,诊断准确、简便,为彻底切除病变提供安全保障。功能性颈清扫术能切除瘘管全程,是一种安全、有效的治疗手段。     

原发性颈淋巴结结核的临床特征与治疗

目的：探讨原发性颈部淋巴结结核的临床特征和治疗方法。方法：回顾性分析32例原发性颈部淋巴结结核患者的临床资料。32例患者中29例活检前行CT检查,4例行细针穿刺针吸活检确诊,28例行手术病理检查确诊。27例行肿块全部切除或区域性颈部淋巴结清扫术,术后全身抗结核治疗6个月;5例确诊后行常规抗结核治疗1年。结果：CT显示肿块呈均匀或不均匀强化,部分肿块呈融合现象。全部病例治疗后均行随访,手术患者术后切口均Ⅰ期愈合,1例术后抗结核治疗3个月肿块增大,再次手术确诊为颈部淋巴结结核并发鼻咽癌颈部淋巴结转移,转肿瘤科治疗,其余31例患者均无颈部淋巴结结核复发和其他结核病表现。结论：原发性颈部淋巴结结核临床特征发生改变,颈部肿块为首发症状,多数位于颈后三角区。CT检查有助于本病的诊断和鉴别诊断。全身抗结核药物和手术切除淋巴结的联合应用能有效地治疗原发性颈部淋巴结结核。原发性颈部淋巴结结核的治疗应以手术为主,手术治疗能缩短治疗时间、减少药物用量及不良反应,防止冷脓肿及窦道形成。     

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。     

Bilateral first and second branchial cleft fistulas: a case report

Branchial cleft anomalies--which include branchial cysts, sinuses, and fistulas--are uncommon developmental defects of the neck. Approximately 2 to 3% of cases are bilateral; bilateral presentations appear to have a familial component. Only 5 cases of bilateral branchial cleft fistulas have been reported in the English-language literature, and only 1 case of simultaneous first and second branchial cleft fistulas has been previously reported. We report what to the best of our knowledge is the second case of bilateral first and second branchial cleft fistulas.     

Anatomical variations of the facial nerve in first branchial cleft anomalies

OBJECTIVE: To review our experience with branchial cleft anomalies, with special attention to their subtypes and anatomical relationship to the facial nerve. STUDY DESIGN: Case series. SETTING: Tertiary care center. PATIENTS: Ten patients who underwent resection for anomalies of the first branchial cleft, with at least 1 year of follow-up, were included in the study. The data from all cases were collected in a prospective fashion, including immediate postoperative diagrams. INTERVENTION: Complete resection of the branchial cleft anomaly was performed in all cases. Wide exposure of the facial nerve was achieved using a modified Blair incision and superficial parotidectomy. Facial nerve monitoring was used in every case. MAIN OUTCOME MEASURES: The primary outcome measurements were facial nerve function and incidence of recurrence after resection of the branchial cleft anomaly. RESULTS: Ten patients, 6 females and 4 males,with a mean age of 9 years at presentation, were treated by the senior author (P.J.K.) between 1989 and 2001. The lesions were characterized as sinus tracts (n = 5), fistulous tracts (n = 3), and cysts (n = 2). Seven lesions were medial to the facial nerve, 2 were lateral to the facial nerve, and 1 was between branches of the facial nerve. There were no complications related to facial nerve paresis or paralysis, and none of the patients has had a recurrence. CONCLUSIONS: The successful treatment of branchial cleft anomalies requires a complete resection. A safe complete resection requires a full exposure of the facial nerve, as the lesions can be variably associated with the nerve.     

Periauricular Cysts and Sinuses

Periauricular cysts, sinuses, and fistulas occur commonly in the pediatric population. They arise from developmental defects of the first branchial cleft and first branchial arch. In most instances the diagnosis and management of these conditions are straightforward, but exceptional presentations sometimes occur. Failure to recognize these unusual cases may result in inadequate treatment and subsequent recurrence, and even if the correct diagnosis is made, surgical management of these lesions may be complicated. A series of 15 cases of periauricular congenital lesions is reviewed, of which three cases illustrating a diagnostic or surgical challenge are presented. The embryology, presentation, and management of these anomalies are discussed. This is one of the largest series of first branchial cleft anomalies reported in the literature, and our paper uniquely discusses first branchial cleft anomalies and preauricular sinuses together, with an emphasis on the surgical management of facial nerve, external ear, and middle ear involvement.     

Recurrence of a deep neck infection: a clinical indication of an underlying congenital lesion

OBJECTIVE: To discuss the computed tomographic (CT) and clinical findings of those entities that may present as recurrent deep neck infections. PATIENTS AND METHODS: Twelve patients with recurrent deep neck infections and CT scans were retrospectively identified since 1990. Their CT scans and medical histories were reviewed. The diagnosis was pathologically confirmed in all cases. RESULTS: The CT scans revealed an abscess or a localized infected cyst in the deep soft tissues of the neck, with varying degrees of associated inflammatory change in the adjacent soft tissues. The diagnoses in these cases included 1 first branchial cleft cyst, 3 second branchial cleft cysts, 1 third branchial cleft cyst, 2 fourth branchial cleft cysts, 2 infected lymphangiomas, 2 thyroglossal duct cysts, and 1 cervical thymic cyst. CONCLUSIONS: Most deep neck infections are the result of suppurative adenitis. The location of the primary focus is usually from the mucosa of the upper aerodigestive tract or from an odontogenic source. Less common causes are perforations due to a foreign body, thrombophlebitis of the internal jugular vein, or osteomyelitis of the spine. Recurrences in these situations are unusual. Less commonly, congenital lesions can present as deep neck infections, and recurrences are common. Our cases suggest that the recurrence of a deep neck infection should alert the physician to the possibility of an underlying congenital lesion and that CT is helpful in the early recognition of these lesions.     

Carcinoma occurring in branchial cleft cysts.

In order to find histological data in the differentiation between branchial cleft carcinomas and metastatic carcinomas, the specimens from 154 patients with branchial cleft cysts and 7 patients with an isolated tumour in the neck with unknown primary tumour were reviewed and compared with 10 normal lymph nodes. Absence of lymph node structures as peripheral lobulation, internodular trabeculae and perinodular sinuses in branchial cleft cystc, are found valuable for distinguishing primary carcinoma of branchial cleft cysts from metastases. A correct diagnosis of this rare tumour is important in order to avoid overtreatment of these patients, who have a good prognosis if treated with surgical excision only.     

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。     

Endoscopic cauterization of fourth branchial cleft sinus tracts

OBJECTIVE: To evaluate the effectiveness of endoscopic cauterization as definitive treatment for fourth branchial cleft sinuses. DESIGN: Retrospective chart review with follow-up questionnaire. SETTING: Tertiary care children's hospital. PATIENTS: Ten children (age range, 10 months to 10 years) with fourth branchial cleft sinuses treated with endoscopic cauterization between 1995 and 2002. MAIN OUTCOME MEASURE: Recurrence of neck infections after endoscopic cauterization of fourth brachial cleft sinus tracts. RESULTS: Seven of the 10 patients treated with endoscopic cauterization of the fourth branchial cleft sinuses showed no recurrence with an average follow-up of 3 years. Three of the patients were unavailable for follow-up, but medical records of the hospital showed no additional admissions for those patients for neck masses. No morbidity of the procedure was identified. All patients were discharged the day of surgery. CONCLUSIONS: Endoscopic cauterization of fourth branchial cleft sinuses appears to be an effective alternative to open excision.