第三、四鳃裂畸形的临床特征及疗效分析

Clinical characteristics and surgical management in patients with third and fourth branchial anomalies

目的：探讨第三、四鳃裂畸形的临床特征、手术方法及手术疗效。方法：对经病理确诊的25例鳃裂瘘管患者行单纯瘘管切除术和选择性颈清扫术。术前均行食管碘水造影及颈部CT、MRI、B超检查。结果：行单纯瘘管切除术的4例患者半年内复发,再次手术时行选择性颈清扫术治疗,随访期内未见复发。23例患者由于反复感染、切开引流或瘘管切除术,导致解剖标志不清,难以找到瘘管,按颈清扫术治疗后治愈。所有患者术后病变组织均送病检,病理回报符合鳃裂瘘管的诊断。术后随访12-36个月,所有经选择性颈清扫术治疗的患者无一例复发,无明显并发症。结论：第三、四鳃裂畸形以复发性急性颈部脓肿或化脓性甲状腺炎或颈下部瘘口分泌物为临床特征,选择性颈清扫术整块切除病变组织是防治复发,有效安全的治疗方法。

Objective：To analysize the clinical characteristics as well as the effect and methods of the surgical treatment in patiets with the third and fourth branchial anomalies.Method：The clinical data of 25 patients diagnosed as third and fourth branchial cleft fistula by pathological method were analyzed retrospectively.Two of 25 patients had undergone fistulectomy simply.Based on the embryologicc and anatomic features of branchial anomalies,23 of 25patients had received different types of selective neck dissection.All of lesions were confirmed as branchial cleft fistula by pathology.All patients were received the examinations of Esophagus myelography,MRI and CT preoperatively.Result：The features of the third and the fourth bianchial fistula were as following：most patients suffered from recurrent neck abscess and had undergone incision and drainage.Esophagus myelography and CT were important auxiliary examination for branchial anomalies.No recurrent and complications were found in all patients by using treatment of selective neck dissection（23/25cases）and fistulectomy simply（2/25cases）within12to 36 months following-up,postoperatively.Conclusion：Branchial anomalies is characterized by recurrent acute abscess,acute thyroiditis or fistula secretion inferior to neck.Complete removal of branchial lesions and inflammatory granuloma using selective neck dissection is a safty and effective treatment for recurrent branchial anomalies.