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目的:分析儿童第四鳃裂畸形的临床特征和颈部开放手术的特征,明确其正确的诊断方法,探讨完整切除病变组织及减少术后并发症的手术技巧。方法:对6例存在梨状窝内窦口的第四鳃裂畸形患儿的流行病学、临床病征、放射影像学、外科手术特征进行回顾性分析,并结合文献对第四鳃裂畸形的正确外科处置方法进行探讨;全部患儿均在导管双向示踪辅助下行颈部开放手术彻底切除瘘管及病变组织,单极电凝补充处理内窦口;系统内镜随访。结果:6例患儿平均随访14个月(1～3年),均无临床症状复发;2例患儿分别在术后第3、4个月内镜随访时发现梨状窝内窦口复发(亚临床症状患儿);6例患儿术后均无声音嘶哑、低沉及饮水呛咳出现。结论:对于儿童反复发作的急性化脓性甲状腺炎和位于颈前区中下部的颈深部脓肿(尤其是病变位于左颈部者)应行CT增强扫描检查和直接喉镜检查以明确有无第四鳃裂畸形病变的存在;直接喉镜检查发现梨状窝尖部内窦口和毗邻Betz黏膜皱襞的存在,术中探查发现瘘管组织穿越环甲膜区域走行于喉上神经以下可确诊为第四鳃裂畸形;颈部开放手术彻底切除瘘管及病变组织是治疗儿童第四鳃裂畸形的有效方法;导管双向示踪有助于术中识别瘘管组织和确定内窦口位置;甲状软骨翼板后下方部分骨质的切除有助于喉返神经的充分显露和保护;甲状腺上极部分腺体的联合切除有助于病变组织的完整切除;单极电凝补充烧灼内窦口黏膜有助于彻底封闭内窦口。
OBJECTIVE: To analyze the clinical features of the fourth branchial gale and the characteristics of open neck surgery in children. The correct diagnosis method is clarified and the surgical techniques for complete resection of the diseased tissue and reduction of postoperative complications are explored. Methods: The epidemiology, clinical signs, radiographic features and surgical features of 6 cases of fourth branchial anastomosis with piriform sinus ostium were analyzed retrospectively. Correct surgical treatment methods were explored; all children were assisted by double-directional catheterization down the neck open surgery to completely remove the fistula and diseased tissue, unipolar electrocoagulation to complement the treatment of the internal ostium; endoscopic follow-up. Results: Six patients were followed up for an average of 14 months (1-3 years), no clinical symptoms were recurred; two cases were found in the pear-shaped sinus sinus recurrence (Children with subclinical symptoms). None of the 6 children had hoarseness and low blood pressure and choking cough after operation. Conclusions: For children with recurrent acute suppurative thyroiditis and cervical deep abscess located in the middle and lower anterior cervical region (especially in the left neck) should be performed CT enhanced scan and direct laryngoscopy to determine whether the fourth Gill schizoid lesions exist; direct laryngoscopy found pear-shaped tip of the tip and adjacent Betz mucosal folds of the existence of intraoperative exploration found that the fistula traversing the annular membrane area of the laryngeal nerve can be diagnosed below the fourth gill Cleft deformity; complete open neck surgery fistula and diseased tissue is an effective method for the treatment of the fourth branchial deformity in children; bi-directional catheterization helps identify fistula tissue and determine the position of the internal ostium; thyroid cartilage wing after the bottom Partial resection of the bone helps to fully reveal and protect the recurrent laryngeal nerve; the combined excision of the glandular part of the upper thyroid gland helps to complete the resection of the diseased tissue; the monopolar electrocoagulation supplements and burns the internal ostium mucosa of the ostium to completely close Internal ostium.