第四鳃裂畸形的诊断和手术治疗

Diagnosis and surgical operation for fourth branchial cleft anomalies

目的:分析第四鳃裂畸形的临床特点,探讨其诊断和手术治疗方法。方法:对10例第四鳃裂畸形患者的临床资料进行回顾性分析,并结合文献对诊断、鉴别诊断及手术治疗方法进行探讨;全部患者均经手术彻底切除病变组织,妥善处理内窦口。结果:随访1～3年,10例均无复发。1例术后即出现声音低沉及饮水呛咳,2周后恢复正常;1例术后即出现伸舌左偏,3个月后复诊恢复正常。结论:反复发作的颈前区中下部的颈深部脓肿及慢性感染窦道,应考虑第四鳃裂畸形的诊断。颈部增强CT扫描及钡餐检查可辅助诊断,病理检查可确诊。手术彻底切除病变组织是治疗第四鳃裂畸形的有效方法,明确内窦道的走行特点及其感染扩散途径,采用选择性颈清扫术的手术原则,是保证彻底切除病变的关键。

Objective：To explore diagnosis and surgical operation through analyzing clinical features of the fourth branchial cleft anomalies.Method：Clinical materials of 10 patients with the fourth branchial cleft anomalies were retrospectively analyzed,and literatures were studied to explore the diagnosis,differential diagnosis and treatment methods of surgical operation;lesions of 10 patients were completely removed by surgical operation,and internal sinus was properly handled.Result：All 10 cases were cured,no recurrence were observed during a follow-up of 1-3 years.1 patient appeared low voice,and drinking cough,back to normality after 2 weeks;1 patient appeared paralysis of left hypoglossal nerves,back to normality after 3 months.Conclusion：Recurrent deep neck abscess and chronic sinus infections of anterior area in the lower part of neck should be considered with the diagnosis of the fourth branchial cleft anomalies.Enhanced neck CT scan and barium sulfate meal examination aid to diagnosis,pathological examination can be confirmed.Complete surgical removal of lesions is an effective treatment of fourth branchial cleft anomalies,knowing of the courses of internal sinus and spread of infection,and use of principle of selective neck dissection is the key to ensure complete removal of lesions.