第三、四鳃裂畸形的诊断与治疗

Diagnosis and Surgical Treatment of Third and Fourth Branchial Anomalies

目的 探讨第三、四鳃裂畸形的临床特征、诊断方法以及手术治疗的技巧与疗效.方法 回顾性分析2002年1月～2013年3月间21例第三、四鳃裂畸形的临床资料.左侧19例,右侧2例.年龄9～53岁,其中40岁以下16例（占76.2％）.完全性瘘管10例,不完全性瘘管11例,其中明确存在梨状窝内瘘口者16例.均采用全麻下颈淋巴结清扫方式行手术治疗,同时行同侧甲状腺腺叶切除16例,行甲状腺部分切除5例.结果 病理均证实为鳃裂畸形.术后咽瘘1例,经换药保守治疗愈合.术后暂时性喉返神经麻痹1例,术后1月复查恢复正常.术后随访均1年以上,未见复发.结论 反复发作的左侧颈根部脓肿或化脓性甲状腺炎应考虑到第三、四鳃裂畸形的可能;采用颈清扫的手术方式行病变区域整块切除并注重内瘘口的处理是防止复发的关键。

Objective To explore the clinical characteristics, diagnosis methods and techniques and curative effect of surgical operation for the congenital third and fourth branchial anomalies. Methods From January 2002 to March 2013, the clinical data of 21 patients with third and fourth branchial anomalies were retrospectively analyzed. 19 cases were left side, 2 were right side. Ages were between 9 to 53 years, 16 patients （76.2%） were younger than 40 years. Of them, 10 cases were totally branchial pouch fistula and 11 were untotally fistula. The internal openings of the fistula to pyriform were identified in 16 cases. All patients were treated by elective neck dissection under the general anesthesia.The ispilateral thyroid lobectomy was performed in 16 cases and partial thyroidectomy in 5 cases. Result All specimens were diagnosed as branchial fistula or cyst by pathology. One case with pharyngeal fistula was healed after dressing changes. A temporary recurrent laryngeal nerve paralysis occurred in one case and completely recovered one month after operation. No recurrences were found within more than one-year postoperative follow-up. Conclusion The third and fourth branchial pouch fistula must be considered in the recurrent lateral deep neck abscess or suppurative thyroiditis, especially in the left side. The key of avoiding recurrence is to apply elective neck dissection for the radical treatment of branchial anomalies and to treat the internal opening of fistula properly.