感染耳前瘘管的临床特征和手术治疗

Clinical Characteristics and Surgical Treatment of Infected Preauricular Fistula

目的探讨感染耳前瘘管的临床特征及有效手术治疗方法;方法总结分析154例165侧感染耳前瘘管的临床表现特征;采用广泛局部切除法切除瘘口、瘘管、感染灶及相关耳廓软骨;需要时酌情选用适合的皮瓣修复缺损。结果普通型耳前瘘管142例153侧,瘘口在外耳道口前上方区域;变异型耳前瘘管共12例/侧,分别开口于耳轮脚、外耳道内、耳廓后上方。感染可发生在瘘口(管)周围任何部位,感染程度可表现为红肿硬结、肿胀渗出、脓肿形成、局部溃破(切开)及炎症疤痕等。术后随访6-36个月,无失访,复发共5例/侧,占3.03%(5/165侧),其中变异型1例/侧,普通型4例/侧,差异无显著性(c2=1.239,P=0.266),其余患者均治愈。用皮瓣修复的患者15例均一期愈合。结论感染耳前瘘管临床表现多种多样;手术切除是治疗感染耳瘘的有效方法,掌握感染耳前瘘管基本知识、保证完整彻底的病灶切除,是减少或避免复发的基本前提。

Objective To report clinical characteristics and surgical treatment of infected preauricular fistula.Methods Clinical features of infected preauricular fistula in 154 cases(165 sites)were reviewed.All patients underwent wide local excision to remove fistula pening and tracts of preauricular together with part of helix cartilage and inflamed tissues.Appropriate flaps were used to repair defects when necessary.Results Classical preauricular fistulas were found in 142 of the 153 sites,with variant types of preauricular sinus in 12 cases/sites.Infection of various degrees manifested as red induration,swelling,exudation,abscess,ulceration(drainage),inflammatory scars et al.All patients were followup for 6-36 months after operation,with recurrence developing in 5 cases/sites(3.03%),in which the variant type was 1 case/side,and classical type were 4 cases/side.the difference was no significant(c2=1.239,P=0.266),the other patients were cured。Repair using flaps was successful in all 15 patients with indicatios.Conclusion Clinical features of infected preauricular fistula are variable.Surgical resection is the effective treatment and complete excision of the primary lesion is critical to prevent recurrence.