感染性先天性耳前瘘管病理组织学观察

发布时间：2019-07-05 08:17

【摘要】：目的:探讨感染性先天性耳前瘘管的病理组织学特点,为降低术后复发率、改进手术方法提供依据。方法:收集感染性耳前瘘管患者25例,其中有感染史非感染期患者14例,处于感染期患者9例,术后复发再手术者2例。手术时整块切除瘘管组织及瘢痕组织。观察分析手术标本并行连续病理切片。结果:1大体形态:有感染史非感染期的手术标本近端为瘘管组织,保持瘘管原有形态,中远端为暗红色实性瘢痕组织;处于感染期的手术标本近端为瘘管组织,远端为肉芽组织和瘢痕组织包绕形成的脓腔,瘘管与脓腔不相交通;术后复发的标本为多囊性肿物,呈典型的哑铃状外观。2组织学观察:有感染史非感染期者和术后复发者镜下可见瘘管远端走行不连续,呈多个束状管腔,管腔之间被条索状纤维组织分隔;处于感染期者镜下除上述表现外,脓腔周围可见新生的毛细血管及浆细胞、淋巴细胞和中性粒细胞浸润。3随访6~12个月,无复发。结论:感染性先天性耳前瘘管组织被瘢痕组织分隔为多段,互不相通,瘘管内注射美蓝等示踪剂无法完整显示瘘管的走行,故单纯依靠示踪剂切除瘘管易致残留。整块切除瘘管组织及瘢痕组织是防止瘘管上皮残留的有效手段,可降低术后复发率。
文内图片：

图片说明：可见切开引流口；图４～６肉眼观察完整病理切片（黑箭头：瘘管口；白箭头：引流口；
[Abstract]:Objective: to investigate the pathological characteristics of infectious congenital preauricular fistula, and to provide evidence for reducing the recurrence rate and improving the surgical method. Methods: twenty-five patients with infectious preauricular fistula were collected, including 14 patients with history of infection in non-infectious stage, 9 patients in infectious stage and 2 patients with recurrent and reoperation after operation. The fistula tissue and scar tissue were resected as a whole during the operation. The surgical specimens were observed and analyzed with continuous pathological sections. Results: 1 Gross morphology: the proximal end of the surgical specimen with a history of infection was the fistula tissue, maintaining the original shape of the fistula, the middle and distal end of the operation specimen was dark red solid scar tissue, the proximal end of the surgical specimen was the fistula tissue, the distal end was the pus cavity surrounded by granulation tissue and scar tissue, and there was no communication between the fistula and the pus cavity. The recurrent specimens were polycystic masses with a typical dumbbell appearance. 2 histologic observation: under microscope, the distal end of the fistula was discontinuity, showing multiple bundles of lumen, separated by striped fiber tissue between the patients with a history of infection in the non-infected phase and the recurrence after operation. In addition to the above findings, neonatal capillaries and plasma cells, lymphocytes and neutrophils were infiltrated around the pus cavity. 3 follow-up for 6 to 12 months showed no recurrence. Conclusion: infectious congenital preauricular fistula tissue is divided into many segments by scar tissue, which is not connected with each other. The injection of methylene blue into the fistula can not completely show the course of the fistula, so it is easy to cause residual after resection of the fistula with tracer alone. Whole resection of fistula tissue and scar tissue is an effective method to prevent fistula epithelial residue, which can reduce the recurrence rate after operation.
【作者单位】：大连大学附属中山医院耳鼻咽喉科;
【分类号】：R764

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