变异型耳前瘘管的诊治分析

Diagnosis and treatment of variant preauricular fistula

目的探讨变异型耳前瘘管的临床特点及手术技巧。方法收集中山大学附属第一医院2000年1月-2014年5月诊治的320例先天性耳前瘘管患者资料，对其中12例（3．75％）资料完整的符合变异型耳前瘘管的患者进行综合分析，收集其临床症状、既往手术史、家族史、手术方式及复发率等。结果此12例变异型耳前瘘管患者均有过瘘管感染病史。4例开口于耳甲腔或耳甲艇，4耳开口于耳轮脚前及耳后沟，1例开口于耳后沟。2例开口于耳轮脚上及外耳道口边缘。1例开口于外耳道口边缘及耳后沟。术后11例患者伤口I期愈合。1例患儿术后5d出现伤口裂开，耳廓部分软骨外露。经纳米银抗菌凝胶处理伤口1周后，创面二期愈合。随访6个月，未见复发。结论临床上仔细的体格检查将避免变异型耳前瘘管的漏诊。各种手术技巧配合显微镜及新颖的抗菌敷料，是治愈变异型耳前瘘管和减少复发的关键。

Objective To analyze the clinical manifestations of and surgical techniques for variant preauricular fistula. Methods Medical records of 320 patients underwent preaurieular fistulectomy in our hospital from Jan 2000 to May 2014 were reviewed. Of them, 12 cases were diagnosed as variant preauricular fistula. Their clinical data including clinical manifestations, family histories, previous surgical histories and procedures, and recurrence rates were analyzed retrospectively. Results Twelve （3.75%） of 320 patients were diagnosed with the variant preauricular fistula. All the cases had history of fistula infection. The locations of fistula orifices were in the cavum conehae or cymba eonchae （4 ears）, ascending helix crus and postauricular area （4 ears）, postauricular area （ 1 ear）, ascending helix crns and external auditory canal （2 ears ）, external auditory canal and postauricular area （1 ear）. The surgical incisions were healed primarily in 11 cases （91.7% , 11/12）. In the case with poor wound healing after operation, nanopartieulate silver gel was used to cover the defects and the wound got healed secondarily. All the 12 patients had been followed up for at least 6 months postoperatively, and recurrence occurred in none with a recurrence rate of 0%. Conclusion A comprehensive physical examination of the preanrieular pits should be performed to avoid missed diagnosis of variant preauricular fistula. Detailed surgical techniques should be performed, and operating microscope and innovative dressings with antibiotic action may facilitate to remove remnants and prevent recurrence.