Kenealy J F, Torsiglieri A J, Tom L W
Department of Pediatric Otorhinolaryngology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Pennsylvania.
Trans Pa Acad Ophthalmol Otolaryngol. 1990;42:1022-5.
Branchial cleft cysts, sinuses and fistulas are among the most commonly encountered congenital anomalies in pediatric otolaryngic practice. They can present difficulties in differential diagnosis and surgical management. In order to study the clinical presentation and surgical management of branchial cleft anomalies, the operative records of the Children's Hospital of Philadelphia (CHOP) were reviewed for a five year period, January 1, 1982 through December 31, 1986. All patients with a pathologically-confirmed post-operative diagnosis of a branchial cleft anomaly were included in a retrospective chart review. Their case histories were studied to determine symptoms upon presentation, presence or absence of drainage, type of lesion, site of lesion, characteristics of the lesion, accuracy of pre-operative diagnosis, recurrence and complications. A total of 71 patients, 39 males and 32 females, underwent surgical excision of a branchial cleft cyst, sinus or fistula during the study period. There were 23 branchial cleft cysts, 50 sinuses and 3 fistulas. A correct pre-operative diagnosis was established in 60 (85%) of the patients, being highest for patients with branchial cleft fistulas. Incorrect pre-operative diagnoses included thyroglossal duct cyst, cervical lymphadenitis, dermoid, dermal inclusion cyst, lymphangioma and malignant neoplasm. The clinical presentation, pre-operative evaluation, pitfalls in diagnosis, surgical management and post-operative complications are discussed and strategies for the management of branchial cleft anomalies are presented.
鳃裂囊肿、鳃裂窦道和鳃裂瘘管是小儿耳鼻咽喉科临床最常见的先天性畸形。它们在鉴别诊断和手术治疗方面可能存在困难。为了研究鳃裂畸形的临床表现和手术治疗，回顾了费城儿童医院（CHOP）1982年1月1日至1986年12月31日这五年期间的手术记录。所有术后病理确诊为鳃裂畸形的患者均纳入回顾性病历审查。研究他们的病史，以确定就诊时的症状、有无引流、病变类型、病变部位、病变特征、术前诊断的准确性、复发情况及并发症。在研究期间，共有71例患者（39例男性和32例女性）接受了鳃裂囊肿、鳃裂窦道或鳃裂瘘管的手术切除。其中有23例鳃裂囊肿、50例鳃裂窦道和3例鳃裂瘘管。60例（85%）患者术前诊断正确，其中鳃裂瘘管患者的诊断正确率最高。术前误诊包括甲状舌管囊肿、颈淋巴结炎、皮样囊肿、皮肤包涵体囊肿、淋巴管瘤和恶性肿瘤。本文讨论了鳃裂畸形的临床表现、术前评估、诊断陷阱、手术治疗和术后并发症，并提出了鳃裂畸形的治疗策略。
