第三鳃裂瘘管7例诊治体会

The clinical experience of seven cases of the third branchial fistula

目的探讨第三鳃裂瘘管有效的诊断和治疗方法。方法回顾性分析2007年1月～2011年12月我院及安徽医科大学第一附属医院耳鼻咽喉科经手术及病理确诊的7例第三鳃裂瘘管患者的临床资料,探讨第三鳃裂瘘管的诊断及手术方法,总结临床经验。结果 7例患者中2例无手术史,5例有2～5次手术史,7例患者根据患者的颈部体征、纤维喉镜检查和影像学检查于术前能确定为第三鳃裂瘘管的有5例,2例行择区性颈清扫术于术中发现瘘管并根据瘘管内口确定为第三鳃裂瘘管,所有病例切口均一期愈合,无并发症。随访3月～5年,无1例复发。结论对于腮裂瘘管应在术前采取多种检查方法以明确其类型有助于提高治愈率,除了碘油造影,下咽稀钡摄片外CT检查对感染期的第三腮裂瘘管具有较高的诊断价值;对于多次手术导致的术前难以确定腮裂瘘管类型的患者行择区性颈清扫术是较好的选择。

Objective To explore effective diagnostic methods and therapeutic strategies for the third branchial fistula. Methods Retrospective analysis was carried out to analyze 7 cases of third branchial fistula confirmed in surgery and by pathology buring January 2007 to December 2011 in Department of Otolaryngology ofAulani Taihe hospital and the First Affiliated Hospital of Anhui Medical University. Results 2 cases had no operative histories, while the other 5 cases had already experienced surgeries for 2 to 5 times. 5 cases were diagnosed before surgery from neck signs, laryngoscopy and imaging scan. And 2 cases were discovered during selective neck dissection and diagnosed as the third branchial fistula by the location of its internal opening. All of the 7 cases recovered in one stage without complications. We followed-up for 3 months to 5 years, and no one recurred. Conclusion It is important to define the type of branchial fistula by varies examinations preoperatively to improve the cure rate. In addition to lipiodol radiography and laryngopharynx dilute barium radiography, CT scan is valuable for diagnosis during infective period. And selective neck dissection is an relatively better choice for those with recurrent branchial fistula which were difficult in classification.