鳃裂囊肿及瘘管诊断和治疗

Diagnosis and treatment of branchial cleft cyst or fistula

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。

OBJECTIVE To investigate the diagno-sis and treatment of branchial cleft cyst or fistula. METHODS Forty-eight patients with branchial cleft cystor fistula from 1991 to 2003 were underwent operationin Shanghai Changzheng Hospital and Qinghai People’sHospital. RESULTS The branchial cleft cyst or fistulamore frequently originated from the second branchialpouch and also can from the first and third branchialpouch. The medical history,location of the lesion and theFNA(f ine needle aspiration hist opatholologicexamination)can help to diagnosis of the branchial cleftcyst or fistula. The long course of the disease and thelesions adhesive to the surrounding tissue make theoperation more difficult. All the cases were removed com-pletely and confirmed by pathology. CONCLUSION Thebranchial cleft cyst or fistula is a rare disease. B ultra-sonography and CT can help the diagnosis of the masswhich is clinically suspected as branchial cleft cyst. Thecyst or fistula should be removed completely and theinternal fistula should be dealt with properly, that maydecrease the recurrence rate. It is important to protectsome key structures including facial nerve,vagus nerveand common carotid artery during operation.