第一鳃裂囊肿及瘘管的诊断治疗

Diagnosis and treatment of the congenital first branchial cyst and fistula

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。

Objective To explore the diagnosis and treatment of the congenital first branchial cyst and fistula. Method The clinical data of 18 patients with first branchial cyst and fistula were retrospectively analyzed. Results Among them, 10 had first branchial fistulas, of which the external blind fistula was between the earlobe and mastoid pro- cess and 6 patients, of which the internal blind fistula located in the boundary of bone and cartilage was in the posterior and lower wall of the external auditory meatus. 8 patients had a branchial cleft cyst, in which the cyst was located in the posterior earlobe in 4 patients, the mandibular angle in 2 patients and the fascia of the parotid gland in 2 patients. All cysts and fistulas were surgically removed. 16 patients were followed up and they thoroughly recovered. Conclusions Congenital first branchial cleft cyst and fistula are rare in the clinic and are easily misdiagnosed and mistreated. Definite diagnosis before operation depends on imaging. The key to cure the diseases is a reasonable operative procedure and com- plete surgical resection is important for avoiding recurrence.