甲状舌管囊肿临床分类与手术关系探讨

A Study on the Relationship between Clinical Classification and Operative Approach of Thyroglossal Cyst

目的 对甲状舌管囊肿进行临床分类 ,并探讨各分类型与治疗的关系。方法 对 13 6例甲状舌管囊肿进行手术 ,其中男 98例 ,女 3 8例 ,年龄 1～ 3 8岁。根据术中美兰染色范围、术中、术后病理分析 ,将其分为 5类 :I、舌骨下囊肿或网状瘘管分枝 ,舌骨上单个瘘管 ;II、舌骨上、下均有囊肿或网状瘘管分枝 ;III、舌骨上囊肿或网状瘘管分枝 ,舌骨下单个瘘管 ;IV、舌骨下囊肿或网状瘘管分枝 ,舌骨上瘘管闭合 ;V、舌骨上囊肿或网状瘘管分枝舌骨下瘘管闭锁。其中舌盲孔和其下瘘管与口腔不通为亚类。结果 I～V类分别占 :5 0 72 %、3 1 62 %、9 5 6%、0 74%、0 %。全组均手术 ,行Sistrunk’s手术 112例 ,不规则手术 2 4例。全组随访 5年 ,2例失访。复发率 :Sistrunk’s手术 7 3 4% ,不规则手术 16 6%。结论 手术后复发与手术中解剖不清致使瘘管组织残留及切除范围有关。对各亚类、以单管形式开口舌盲孔 ,应行Sistrunk’s手术 ;舌盲孔和其附近网状瘘管与口腔通畅者 ,此网状分枝以下瘘管、囊肿必须切除。

Objective To classify thyroglossal cyst, and explore the relation between its clinical classification and operative manner. Methods 136 cases of thyroglossal cyst were treated by surgery. Among them, 98 were male and 38 were female. Their ages were 1 to 38 years old. According to intraoperative findings and postoperative pathological examination, thyroglossal cyst was classified into 5 types: inferior glossohyal cyst or complex network fistula, and single superior glossohyal fistula(type I); inferior and superior glossohyal cyst or complex network fistula(type II); superior glossohyal cyst or complex network fistula, and single inferior glossohyal fistula(type III); inferior glossohyal cyst or complex network fistula, and closed superior glossohyal fistula(type IV); and superior glossohyal cyst or complex network fistula, and closed inferior glossohyal fistula(type V). Lingual foramen cecum and fistula without connection with oral cavity was classified into subtype. Results Patients with types 1 to 5 accounted for 50.72%, 31.62%, 9.56%, 0.74%, and 0, respectively. 112 patients underwent Sistrunk's operation, and the other 24 cases underwent irregular operation. All the patients were followed up for 5 years after operation. Recurrent rate after Sistrunk's operation was 7.34%, and that after irregular operation was 16.6%. The main reasons of recurrence were unclear anatomy, residual fistula, and not enough excision range. Conclusion For all types of thyroglossal cyst including single canal opening from lingual foramen cecum, Sistrunk's operation should be performed. If lingual foramen cecum and nearby network fistula are connected with oral cavity, the network fistula and cyst must be excised.