鳃裂畸形的临床分析

发布时间：2018-06-28 15:21

本文选题：鳃裂畸形 + 先天性疾病　；参考：《吉林大学》2012年硕士论文

【摘要】：目的：通过总结分析63例鳃裂畸形病例临床资料，进一步探讨鳃裂畸形发病特点，探究更为优化的治疗方案。方法：收集吉大一院2005年至2012年鳃裂畸形病例。根据鳃裂畸形的位置，分为第一鳃裂畸形，第二鳃裂畸形，第三、四鳃裂畸形。统计患者性别、发病年龄、病程时间、主诉及伴随症状、是否有颈部感染史、是否有手术史、辅助检查结果、手术方式的选择、术后病理情况、术后并发症的发生及术后随访是否有复发。进而分析鳃裂畸形发病临床特点、辅助检查的选择及优势、鉴别诊断、手术方式的选择、术后复发的原因、鳃裂癌临床特点。结果：63例病例中，第一鳃裂畸形15例，第二鳃裂畸形36例，第三、四鳃裂畸形12例，鳃裂畸形中男性病例为32例，女性病例31例。鳃裂畸形平均发病年龄约为22岁。鳃裂畸形平均病程为33个月。鳃裂畸形中左侧有44例，右侧有15例，双侧2例，正中2例。术后病理鳃裂囊肿49例，鳃裂瘘管14例。鳃裂畸形有43例术前行超声检查，9例术前行CT检查。第一鳃裂畸形13例手术切除肿物，1例行脓肿切开引流术，1例行保守治疗；第二鳃裂囊肿中有25例肿物切除术，9例行脓肿切开引流术，1例行扁桃体切除加囊肿切除术，1例行保守治疗；第三、四鳃裂囊肿8例行肿物切除术，3例行脓肿切开引流，1例行鳃裂囊肿切除加甲状腺左叶部分切除术。术后并发症2例，颈部切口感染1例，暂时性喉返神经麻痹1例。有8例鳃裂畸形术前有脓肿切开引流术。术后随访有3例术后复发，再次手术。鳃裂癌1例，肿物位于右侧伴颈部淋巴结转移，行右侧选择性颈淋巴结清扫术。结论：鳃裂畸形以儿童期发生率最高，随年龄增长发生率递减。患者平均病程较长，不同鳃裂畸形发病特点不同导致平均病程不同。鳃裂畸形发病以第二鳃裂畸形为主，但第一鳃裂畸形及第三、四鳃裂畸形，发病率实际上并不低。鳃裂畸形以左侧较右侧多见。鳃裂畸形手术复发原因主要包括术前感染史，鳃裂畸形分支的处理，与周围结构的解剖关系，内瘘口的处理，诊治经过及患者自身原因等。
[Abstract]:Objective: to summarize and analyze the clinical data of 63 patients with branchial cleft deformity, to explore the characteristics of Gill cleft malformation and to explore a better treatment scheme. Methods: the patients with branchial cleft deformity from 2005 to 2012 were collected. According to the location of the branchial cleft malformation, it can be divided into the first branchial cleft malformation, the second branchial cleft malformation and the third and fourth branchial cleft malformation. Gender, age of onset, duration of disease, main complaint and associated symptoms, history of neck infection, history of operation, results of auxiliary examination, choice of operation mode, postoperative pathological situation, The occurrence of postoperative complications and postoperative follow-up whether there is recurrence. Then the clinical characteristics of Gill cleft deformity, the choice and advantage of auxiliary examination, the differential diagnosis, the choice of operation mode, the cause of postoperative recurrence and the clinical characteristics of Gill cleft carcinoma were analyzed. Results among 63 cases, 15 cases were first branchial cleft malformation, 36 cases were second branchial cleft malformation, 12 cases were third and fourth branchial cleft malformation, 32 cases were male and 31 cases were female. The average onset age of branchial cleft deformity was about 22 years old. The mean duration of branchial cleft deformity was 33 months. 44 cases were left side, 15 cases were right side, 2 cases were bilateral and 2 cases were median. Postoperative pathological branchial cleft cysts in 49 cases, branchial fistula in 14 cases. 43 cases of branchial cleft deformity were examined by ultrasound before operation and 9 cases by CT before operation. 13 cases of the first branchial cleft deformity were surgically removed and 1 case underwent abscess incision and drainage and 1 case was treated conservatively. Of the second branchial cleft cysts, 25 cases were treated with tumor excision 9 cases with abscess incision and drainage and 1 case with tonsillectomy plus cystectomy and 1 case with conservative treatment. Four branchial cleft cysts were resected in 8 cases and abscess incision and drainage were performed in 3 cases. Branchial cleft cyst resection and partial thyroidectomy were performed in 1 case. Postoperative complications in 2 cases, cervical incision infection in 1 case, temporary recurrent laryngeal nerve paralysis in 1 case. Abscess incision and drainage were performed in 8 patients with branchial cleft malformation before operation. There were 3 cases of postoperative recurrence and reoperation. One case of branchial cleft carcinoma, the tumor located in the right with cervical lymph node metastasis, right selective neck lymph node dissection. Conclusion: the incidence of branchial cleft deformity is the highest in childhood and decreases with age. The mean course of disease was longer, and the characteristics of different branchial deformities resulted in different mean course of disease. The main malformation of branchial cleft was the second branchial cleft, but the first branchial deformity and the third and fourth branchial deformity had not low incidence. Branchial cleft deformity was more common in left side than in right side. The causes of surgical recurrence of Gill cleft deformity include the history of infection before operation, the treatment of branchial branches of Gill cleft deformity, the anatomical relationship with the surrounding structure, the treatment of internal fistula, the diagnosis and treatment, and the causes of the patients themselves.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R762

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