甲状舌管囊肿和瘘管术后复发的手术治疗

目的 探讨甲状舌管囊肿和瘘管术后复发再次手术的策略.方法 对2000-2006年收治的16例甲状舌管囊肿和瘘管术后复发患者进行回顾性分析.男10例,女6例.复发时间为术后6个月至4年,复发时年龄为12～35岁.对术中发现前次手术未切除舌骨中段者(10例),行常规Sistrunk术式手术切除;对前次手术切除舌骨中段者(6例),行扩大切除反复感染致与周围粘连组织,即扩大Sistrunk术式.结果 16例复发患者再次手术后,疗效满意.术后并发咽瘘和颈前血肿各1例,治疗后痊愈.随诊1～6年未见囊肿或瘘管复发.结论 合理应用常规Sistrunk术式与扩大Sistrunk术式是治疗甲状舌管囊肿复发病例的理想方法.     

甲状舌管囊肿术后复发的原因和处理

目的探讨甲状舌管囊肿术后复发的原因和预防、处理措施。方法回顾性分析10例甲状舌管囊肿术后复发患者的资料。10例复发甲状舌管囊肿行Sistrunk术式再次手术切除。结果误诊和不当的手术方法是复发的主要原因。10例患者再次手术后,随访1年以上,疗效满意,未见有复发病例。结论正确的术前诊断,规范的Sistrunk术式和良好的手术技巧才能保障彻底地切除甲状舌管囊肿。     

甲状舌管囊肿及瘘36例治疗效果分析

目的探讨甲状舌管囊肿及瘘管术后复发的原因及预防措施.方法对36例甲状舌管囊肿及瘘病例行Sistrunk术式,术前注入美蓝液于囊管内,以便术中分离追踪蓝染管支,切除足够舌骨中段,近舌盲孔处行荷包缝合术或电凝、微波等处理.结果36例中34例治愈,随访1年以上未见复发,2例复发,经再次手术治愈,复发率5.6%.结论对甲状舌管囊肿及瘘患者,术前、术中、术后处理好每个环节,是防止复发的关键.     

舌根部甲状舌管囊肿的诊断与治疗

目的 探讨发生于舌根部的非典型甲状舌管囊肿的临床表现、诊断和治疗方法.方法 回顾分析4例发生于舌根部的甲状舌管囊肿患者的临床资料,手术采用支撑喉镜下激光切除术和颈外径路Sistrunk术.结果 咽部异物感、咽部阻塞感是发生于舌根的甲状舌管囊肿的主要临床表现;颈部超声和CT检查是明确诊断的主要检查方法.支撑喉镜下激光手术无一例外均导致囊肿复发,3例复发1次,1例复发3次,颈外径路Sistrunk术将囊肿完整切除.结论 发生于舌根的甲状舌管囊肿应常规行颈部超声和CT检查,以明确诊断;治疗首选颈外径路Sistrunk术式.     

扩大Sistrunk手术切除复发舌甲状舌管囊肿的临床分析

目的　分析舌甲状舌管囊肿（lingual thyroglossal duct cysts,LTGDC）的临床特征,探讨行扩大Sistrunk手术切除复发LTGDC的临床疗效。方法　回顾性分析2007年6 月～2018年1月在我科收治的15例LTDGC临床资料,男11例,女4例,年龄18～55岁。12例患者既往有1～3次不等的手术切除史,手术后2周～10个月间复发。手术均经颈前入路进入咽腔,采用扩大的Sistrunk术式切除囊肿。结果　术后咽瘘1例,经换药保守治疗愈合。1例行气管切开,出院前拔管。患者术后均无吞咽不适及言语异常。所有患者均随访2年以上无复发。结论　LTDGC临床误诊率高,经内镜下切除容易复发。采用颈前入路扩大Sistrunk术式切除LTGDC为首选术式,临床效果可靠。     

舌根部甲状舌管囊肿的诊断与治疗经验北大核心CSCD

目的探讨舌根部甲状舌管囊肿的影像学检查、临床表现、手术方式、并发症及术后疗效。方法回顾性分析2015年1月至2018年10月经郑州大学第一附属医院收治,通过手术确认的30例舌根部甲状舌管囊肿患者的临床资料。结果30例舌根部甲状舌管囊肿患者首次手术均为支撑喉镜下低温等离子切除术,共随访7.5~45.0(25.4)个月,25例未复发,2例失访,2例复发1次,1例复发2次,复发率为10.7%(3/28)。2例复发1次的患者,末次手术均行支撑喉镜下低温等离子切除术,1例复发2次患者末次手术行Sistrunk手术;3例复发患者均术后随访1年未见复发。28例患者术后均无咽瘘、声嘶。结论舌根部甲状舌管囊肿,尤其是首发患者且年龄较小,可首选支撑喉镜下低温等离子切除术,复发的舌根部甲状舌管囊肿可再次行支撑喉镜下低温等离子切除术,多次复发患者可考虑Sistrunk手术。     

甲状舌管癌五例的临床特点及诊治分析

目的 探讨甲状舌管癌的临床特点、诊断、手术范围及预后.方法 回顾性分析1991-2011年收治的110例甲状舌管疾病患者的临床资料,其中5例经术后病理确诊为甲状舌管癌,乳头状癌4例,鳞状细胞癌1例.5例患者均为男性;年龄17～73岁,中位年龄41岁.1例乳头状癌患者术前即合并肺转移.5例患者均行手术治疗,其中2例接受Sistrunk术(切除肿瘤、甲状舌管及部分舌骨),1例行Sistrunk术+甲状腺结节切除术,1例合并肺转移的患者行Sistrunk术+甲状腺全切除术+中央区淋巴清扫术,1例鳞癌患者行Sistrunk术+受侵组织扩大切除术.结果 术后2例乳头状癌患者行促甲状腺激素抑制治疗,其中1例合并肺转移患者行核素治疗,其余3例患者均未行进一步治疗.术后随访14 ～45个月,1例73岁甲状舌管鳞癌患者术后2个月复发,并于术后7个月死于肿瘤复发,其余患者均生存.结论 甲状舌管癌临床少见,确诊依赖术后病理检查,外科手术为主要治疗手段.对于低危患者,Sistrunk术式可能是一种合适的治疗方法.     

颈外径路Sistrunk手术治疗成人复发性舌甲状舌管囊肿的临床分析

目的 探讨成人复发性舌甲状舌管囊肿（LTGDC）的临床特点、误诊原因及手术治疗。方法 回顾性分析2018年1月—2021年3月收治的6例反复复发的成年LTGDC患者,术前行甲状腺B超提示甲状腺位置并排除异位甲状腺,颈部CT检查明确肿物大小、部位及与舌骨的关系,喉咽部MRI明确肿物性质。手术均采用颈外径路Sistrunk手术。结果 6例患者曾误诊为会厌囊肿4例,舌根囊肿2例,均已行囊肿切除术,复发时间3周至1年。所有患者行颈外径路Sistrunk手术完整切除甲状舌管囊肿及瘘管,术后病理确诊为甲状舌管囊肿。术后随访1年以上无复发。结论 复发性舌根部或会厌间隙的囊性肿物应考虑LTGDC的可能性。所有患者术前均应行喉镜检查和颈部影像学检查以了解囊肿的形态、位置及其和舌骨的关系来选择手术方式。对于成人复发性LTGDC,Sistrunk手术可彻底切除囊肿减少复发。     

扩大舌骨及周围组织切除治疗复发性感染性甲状舌管囊肿及瘘管

甲状舌管囊肿及瘘管是颈部常见的先天性畸形,手术切除是其惟一的治疗方法.由于甲状舌管的范围不确定,早期简单囊肿切除术式常有残留,导致复发.我们在Sistrunk术式的摹础上,扩大舌骨及其周围组织的切除范围,治疗38例复发感染性甲状舌管囊肿及瘘管,现报告如下.     

111例甲状舌管囊肿及瘘管临床分析

目的　探讨甲状舌管囊肿及瘘管的临床诊治方法。方法　回顾性分析甲状舌管囊肿及瘘管患者111例的临床资料,对其临床特点、诊疗方法、术后并发症进行总结分析。结果　术后复发5例,其中4例有反复囊肿感染病史,术后呼吸困难2例,其中1例患者因长时间缺氧出现缺血缺氧性脑病,术后咽瘘1例。结论　手术方式和感染史是甲状舌管囊肿及瘘管术后并发症和复发的重要影响因素,病灶反复感染以及术后复发者易切除过多周围组织,术中应仔细结扎舌骨离断处减少咽瘘发生。颈部手术术后24 h应密切关注患者呼吸情况,切除范围大手术时间延长者术后可延迟拔管、予以激素治疗防止会厌前间隙水肿导致呼吸困难。     

内镜下低温等离子治疗舌甲状舌管囊肿

目的：探讨内镜下低温等离子治疗舌甲状舌管囊肿的手术方法、疗效和适应证。方法：对11例舌甲状舌管囊肿患者行内镜下低温等离子舌甲状舌管囊肿切除术,观察疗效及并发症情况。结果：1l例患者术后症状改善,无严重并发症发生,随访1-3年,无复发。结论：内镜下低温等离子治疗舌甲状舌管囊肿手术时间短,术中出血少,术后反应轻、恢复快,疗效满意。     

复发性甲状舌管囊肿(瘘管)的原因探讨和预防措施

目的：探讨甲状舌管囊肿（瘘管）术后复发的原因和提高手术疗效的措施。方法：对３２例甲状舌管囊肿（瘘管）病例（含８例术后复发者）,术前感染病例先行抗炎后再手术,准确判定甲状舌管囊肿与舌骨的关系,处理舌骨;术中衔注美蓝液入囊管内示踪,行Ｓｉｓｔｒｕｋ术式,分离小分支,以手术显微下失去示踪小支,手指接触诊疑为残存病灶处,行环形缝扎或电凝,射频等处理。结果：３２例均获成功,随访１年以上未见复发。结论：对甲状     

Thyroglossal duct remnants

Thyroglossal duct remnants presenting as a lump in the neck are usually called thyroglossal cysts. Meticulous dissection of the cyst and duct, along with the body of the hyoid bone (Sistrunk's operation) is necessary to avoid recurrence. The authors have reviewed the histology of 61 consecutive specimens diagnosed preoperatively as thyroglossal cysts and have found that a true cyst exists in only 46 per cent of cases.     

甲状舌管癌的临床诊治并文献复习（附2例报告）

目的通过对甲状舌管癌患者的诊断和治疗,并复习相关文献,总结该病的临床特征和准确制定合理的治疗方案。方法报道2例甲状舌管癌患者的诊治过程,影像学特点及治疗方法。结果2例患者术前均被误诊为甲状舌管囊肿,常规行Sistrunk手术,术后病检1例为甲状舌管乳头状癌,另1例为甲状腺乳头状癌,结合术中所见最后诊断为甲状腺舌管乳头状癌,2例术后复查甲状腺功能均正常,复查甲状腺超声未见明显恶性肿瘤特征,均未行甲状腺手术治疗,1例未做任何其他补充治疗,随访8年无局部复发和转移,另1例行甲状腺素抑制治疗随访1年无复发。结论甲状腺舌管癌临床罕见,术前易误诊为甲状舌管囊肿,术前超声及增强CT有助于诊断,需病理确诊,手术方案的制定需综合考虑,病理分型决定其预后。     

A 16-year experience in treating thyroglossal duct cysts with a “conservative” Sistrunk approach

Although Sistrunk operation is the standard method to treat thyroglossal duct cyst, the reported recurrence rates after a “classic” or “modified” Sistrunk procedure still varied from 0 to 15.8 %, indicating the existence of some technical uncertainties. While simple cystectomy has been recognized as the most important prognostic factor predicting thyroglossal duct cyst recurrence, whether other clinico-pathological parameters also affect disease recurrence has not been well studied. We retrospectively reviewed the medical records of all patients who underwent thyroglossal duct cyst surgery between June 1998 and June 2014 at our institution. Among the 180 primary patients, 160 patients received a “conservative” Sistrunk operation, while the remaining 20 patients received simple cystectomy only. Five patients (2.8 %, 5/180) had recurrence. Four of them received simple cystectomy while 1 had “conservative” Sistrunk operation. In univariable analysis, age (p = 0.02), history of previous infection (p = 0.004) and the type of resection (p = 0.001) were significantly correlated with disease recurrence. In multivariable analysis, the type of resection turned out to be the most important factor (p = 0.03) related to recurrence. In the most parsimonious model selected by backward elimination, both history of infection (p = 0.048) and the type of resection (p = 0.02) were important predictors of postoperative recurrence. Our results demonstrated that a “conservative” Sistrunk approach could provide a comparably low recurrence rate (0.6 %, 1/160) in dealing with primary thyroglossal dust cysts. Routine dissection of suprahyoid tissue may not be imperative. Overall, the type of resection and history of infection are the most important predictors of recurrence for thyroglossal duct cyst.     

30例小儿甲状舌管囊肿术后不置引流管的临床分析

摘要：目的探讨小儿甲状舌管囊肿术后不置引流管的可行性。方法通过回顾性分析昆明市儿童医院2016年1月~2017年1月30例初发甲状舌管囊肿而术后未置引流管的患儿，在年龄、性别及手术方式有可比性的前提下，通过疼痛评分量表的观察并记录术后1、2、3、4、48 h的疼痛情况，同时观察并记录术后血肿、皮下积气、切口感染、咽瘘、声音嘶哑、舌肌运动困难、吞咽困难、呼吸困难及发声困难等并发症的发生率以及随访半年的复发情况来判断术后未置引流管的影响。结果患儿在年龄、性别、手术方式等方面有可比性的情况下，初发甲状舌管囊肿而术后未放置引流管的30例患儿均未发现血肿、皮下积气等上述并发症，随访半年均未见复发。结论小儿甲状舌管囊肿术后不置引流并不增加术后并发症发生率及复发率，并且不置引流可以增加患儿舒适度，减轻术后疼痛，减少患儿自主拔出引流管的可能性以及降低术后护理难度。因此，甲状舌管囊肿术后可不常规放置引流管。     

Management of incidental thyroglossal duct cysts during laryngotracheal reconstruction

Thyroglossal duct cysts originate from trapped elements of the thyroglossal duct tract during embryological descent of the thyroid gland. The incidental finding of a thyroglossal duct cyst during cervical surgery has not been described previously. We present four cases of small asymptomatic thyroglossal duct cysts discovered as an incidental finding during laryngotracheal reconstruction. In each case, the cyst was removed using a Sistrunk procedure. In all four cases the patient was successfully decannulated, and there were no cases of cyst recurrence. We also consider the implications that these four cases may have on the perceived incidence of the thyroglossal duct cysts and their management.     

Cysts of the thyroglossal duct

Experiences with 53 consecutive patients undergoing surgical excision of thyroglossal duct cysts are reported. Four patients (7.5%) developed recurrent cysts after surgery. Analysis of cases revealed the following factors to contribute to an increased risk of recurrence: young age, skin involvement by the cyst, lobulation of the cyst, rupture of the cyst, and failure to follow the second principle advocated by Sistrunk.     

Endoscope-assisted concurrent resection of thyroglossal duct cysts and benign thyroid nodules via a small submental incisions

The objective of this study was to evaluate the technique of endoscope-assisted concurrent resection of thyroglossal duct cysts and benign thyroid nodules via a small submental incision. Endoscope-assisted thyroglossal duct cyst excision and subtotal thyroidectomy were performed via a small submental incision in six patients with thyroglossal duct cysts and benign nodular thyroid lesions. The thyroglossal duct cysts and thyroid lesions were completely excised. The incisions were 3–4 cm in length, and the mean operation time was 84 ± 11 min. The mean volume of blood loss was 19 ± 5 mL. Postoperative pathological examination findings confirmed the diagnosis of thyroglossal duct cyst in all patients. The thyroid lesions were nodular goiter in three patients and thyroid adenoma in three patients. No postoperative complications such as hematoma, pharyngeal fistula, hypocalcemia, recurrent laryngeal nerve paralysis, or dysphagia were observed. No changes in the planned surgical procedure were required, and no recurrent lesions were detected during follow-up. In conclusion, patients with thyroglossal duct cysts and benign thyroid lesions can be treated by endoscopic excision via a small submental incision, thereby avoiding large neck incisions and resulting in better postoperative cosmetic outcomes.