摘要
目的 探讨第四鳃裂畸形的诊断要点、手术经验及疗效。方法 回顾性分析2014年4月~2021年2月我科于支撑喉镜辅助下颈部开放手术治疗的第四鳃裂畸形12例,总结其临床特点、手术发现、术后并发症及预后。结果 所有病例均于术前及术中确诊。10例为第四鳃裂瘘管,均发生于左侧;2例为第四鳃裂窦道,均发生于右侧。术前确诊10例(83.3%),瘘口位于梨状窝尖内;术中支撑喉镜检查确认梨状窝尖内瘘口11例(91.7%)。所有患者的颈部病变均可追踪至甲状软骨下角及环甲间隙附近。11例一期完整切除病变。所有患者围手术期均未出现声音嘶哑。1例患者术后1年复发,乃因首次手术未找到梨状窝尖内瘘口,再次手术发现梨状窝尖内瘘口而完整切除,随访4年未再复发。结论 全麻下行梨状窝支撑喉镜检查,是诊断第四鳃裂畸形的可靠方法,支撑喉镜辅助颈部开放手术是根治第四鳃畸形的有效方法。
Objective To sum up the clinical experience with the treatment of malformations in the fourth branchial cleft treated by open neck excision assisted by self-retaining laryngoscope.Method Included in this retrospective analysis were 12 patients with malformations in the fourth branchial cleft,treated at our Department from Apr 2014 to Feb 2021.All these patients were treated with open neck excision assisted with self-retaining laryngoscope.Then,summarized were the clinical manifesting features,findings during the operative,operative complications,and prognosis of patients with such a condition.Results The definite diagnosis of these patients was made before the operation and/or confirmed during the operation.Among them,10 patients were determined as fistula in the fourth branchial cleft on left,and 2 were as sinus in the fourth branchial cleft on right.For the 10 cases(83.3%) with a definite diagnosis made before the operation,the internal orificium fistulae were all located within the apex of the pyriform sinus,while 11(91.7%) cases were found with their internal orificium fistulae located within the apex of the pyriform sinus confirmed under the self-retaining laryngoscope.All the lesions in the neck among these cases could be tracked to the vicinity of inferior cornu of the thyroid cartilage and the cricothyroid space.Complete resection of the lesions was achieved among 11 cases at stage one.No vocal cord paralysis occurred following the operation.Only one case was found with the lesion reoccurred one year after the operative because of the internal orificium fistulae not confirmed during the period of surgery,but it was cured by a reoperation with the internal orificium fistulae definitively determined within the apex of the pyriform sinus under the self-retaining laryngoscope,with the lesion no reoccurring during a following up period lasted for 4 years.Conclusion It should be true,based our clinical experience,that the reliable way to diagnose the malformation in the in the fourth branchial cleft might be via a careful examination to the pyriform sinus by a self-retaining laryngoscope under general anesthesia,and such a surgical procedure as open neck excision assisted by self-retaining laryngoscope might be an effective way to cure such a lesion.
作者
师娟
董研博
路承
刘良发
李万鑫
SHI Juan;DONG Yanbo;LU Cheng;LIU Liangfa;LI Wanxin(Department of Otolaryngology-Head and Neck Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing,100050,China)
出处
《中国中西医结合耳鼻咽喉科杂志》
2024年第1期65-69,共5页
Chinese Journal of Otorhinolaryngology in Integrative Medicine
关键词
第四鳃裂畸形
临床特点
手术要点
疗效
the fourth branchial cleft malformation
clinical features
operation essentials
therapeutic effect
