耳后发际入路内镜辅助第二鳃裂囊肿切除术与传统术式的对照研究

A comparison between endoscopic-assisted second branchial cleft cyst resection via retroauricular hairline approach and conventional second branchial cleft cyst resection

目的:与传统经颈入路比较,评价耳后发际入路内镜辅助第二鳃裂囊肿切除术的可行性和利弊。方法:前瞻临床对照研究,25例第二鳃裂囊肿,13例接受耳后发际入路内镜辅助手术;12例接受传统经颈入路手术。术前,影像学(B超、CT或MRI)评估囊肿大小、位置、毗邻,并行细针穿刺组织学活检明确病理。两组比较切口长度、手术时间、术中出血量、术后并发症、切口美容效果等。结果:所有病例均顺利完整切除。内镜组切口长度、手术时间显著大于传统组(P<0.05);术后3个月,内镜组切口美容效果显著高于传统组(P<0.01)。术后内镜组出现1例(7.7%)暂时性耳垂麻木,1例(7.7%)耳后发际皮瓣游离缘皮肤淤紫,均在术后1个月缓解。所有病例随访18～36个月(中位随访26个月),未见复发。结论:耳后发际入路内镜辅助第二鳃裂囊肿切除术安全、可行。与传统经颈入路比较,优点为切口隐蔽、美容效果确切,并发症少。

Objective： To assess the feasibility, risks and advantages of endoscope-assisted second branchial cleft cyst（SBCC） resection via the restroauricular hairline approach（RHA） by comparing with conventional trans- cervical approach. Method：Using prospective clinical controlled study, in twenty five patients with SBCC, 13 cases underwent endoscope-assisted resection via the RHA, 12 cases underwent conventional transcervical approach re section. Preoperatively, the sizes, locations and adjacency of all lesions were evaluated by ultrasonography ,CT or MRI. Pathologic diagnoses of all cases were identified as SBCC using fine needle aspiration biopsy. Two groups were compared at length of incision, operation time, bleeding, incision cosmetic result, complication etc. Result： All 25 operations were successfully performed. Length of incision and operation time in endoscopic group were signifi- cantly longer than that of the trancervical group（P〈0.05）. After three months, the mean subjective satisfaction score of incision scar in the endoscopic group was significantly higher than that of traneervical group（P〈0.01 ）. In endoscopic group, 1 cases（7.7%） with temporary numbness of earlobe and 1 case（7.7%） with a darkened color change of the flap margin at the incision angle were found postoperatively. However, they were recovered within 1 month. All the 25 patients were disease free with a follow-up from 18 to 36 months（median follow-up： 26 months）. Conclusion：Endoscope-assisted SBCC resection via RHA is feasible and safe for the treatment of SBCC. In comparison with the transcervical approach, this method can provide an invisible incision and better cosmetic re- sults without significant complications.