复发性先天性颈侧瘘管及囊肿治疗方式的回顾性分析

Retrospective analysis of the treatment of recurrent congenital fistula or cyst in lateral cervical part

目的:总结39例复发性先天性颈侧瘘管及囊肿患者的治疗经验,以期提高颈侧瘘管及囊肿的治愈率。方法:回顾性分析39例手术切除后复发的颈侧瘘管及囊肿患者的诊治过程。其中第一鳃裂来源12例,第二鳃裂来源6例,第三鳃裂来源21例。结果:所有患者经历瘘管或囊肿切除手术2～5次。最后1次术后随访9个月～17年,6例失访;6例复发(第一鳃裂瘘管1例,第二鳃裂瘘管3例,第三鳃裂瘘管1例、囊肿1例);1例第一鳃裂瘘管患者第3次术后发生癌变,第4次术后1年死亡。2例第三鳃裂瘘管穿过甲状腺,术中切除瘘管穿行的甲状腺组织。所有术中找到明确内口并进行有效结扎的颈侧瘘管患者术后在随访期间均未见复发。结论:提高对颈侧鳃裂畸形的认识,合理选择手术时机,制定有效的手术方案是复发性颈侧瘘管治愈的关键。

Objective：To analysis the therapeutic procedure on the recurrent congenital fistula or cyst in lateral cervical part.Method：Thirty-nine cases with recurrent congenital fistula or cyst in lateral cervical part were enrolled in this study including 12 cases from the first branchial cleft,6 from the second branchial cleft and 21 from the third branchial cleft.Result：All the cases underwent fistula or cyst excision for 2 to 5 times in their whole therapeutic process,not counting the incision and drainage.During 9 months to 17 years＇ follow-up,fistula or cyst in 6 cases relapsed,including 1 fistula from the first branchial cleft,3 fistulae from the second branchial cleft,1 fistula and 1 cyst from the third branchial cleft,respectively.One case with recurrent fistula from the first branchial cleft was diagnosed temporal verrucous carcinoma six months after the third fistula excision operation and died one year after the forth operation probably due to the intracranial metastasis of temporal bone verrucous carcinoma.In two cases,the fistulae went through the thyroid gland to the piriform fossa and both the fistulae and part of the thyroid glands were resected.In the patients whose inner orificium fistulae were found and ligated effectively,no recurrence occurred during the followed-up period.Conclusion：The key point to cure the recurrent congenital fistula or cyst in lateral cervical part lies in proper occasion of operation,stain tracing in operation and reasonable program of operation.