31例鳃裂发育畸形临床诊治分析

Diagnosis and treatment of branchial cleft malformations

目的探讨鳃裂发育畸形的临床诊治。方法回顾性分析31例鳃裂瘘管、窦道及囊肿诊治情况,其中第一鳃裂瘘管7例,第二鳃裂瘘管6例、鳃裂窦道及囊肿12例,第三鳃裂瘘管6例。初次手术者16例,复发再次手术者15例。结果经合理用药,术中熟悉瘘管行走途径,精细解剖,彻底切除瘘管、窦道及囊肿,1例出现面神经下颌缘支不全麻痹;1例出现咽瘘,经换药后痊愈。其中27例随访1年以上,截止目前无1例再次复发。结论熟悉各型鳃裂畸形的发病机制及颈部解剖,合理选择手术时机是治愈该种疾病的关键。

Objective To explore the clinical diagnosis and treatment of branchial cleft malformations （ fistula, sinus and cyst）. Methods The clinical experience of diagnosis and treatment of 31 patients with branchial cleft malformations was summarized. Of them, 7 cases suffered from the first branchial fistula, 6 from the second branchial fistula, 12 from fistula and cyst of the second branchial cleft, and 6 from the third branchial fistula. As for the treatment, 15 cases received revision surgery due to recurrence and 16 were operated for the first time. Results With preoperative rational use of drugs and intra-operative careful dissection, the fistulae, sinuses and cysts were completely excised in all patients. As for the postoperative complications, incomplete palsy of marginal mandibular branch of facial nerve occurred in one patient and pharyngeal fistula in another one. Both of them got cured with conservative management. 27 patients were followed up for more than one year postoperatively, and four have been following up. Up till now, no one got relapse. Conclusions Be familiar with the pathogenesis of branchial cleft malformations and anatomy of neck, and appropriate choice of operation time are keys to cure these malformations.