Ding Xiao-Qiong, Zhu Xin, Li Ling, Feng Xu, Huang Zhi-Chun
Department of Otolaryngology Head and Neck Surgery, Zhongda Hospital Southeast University, Nanjing 210000, Jiangsu Province, China.
World J Clin Cases. 2019 Dec 6;7(23):3957-3963. doi: 10.12998/wjcc.v7.i23.3957.
Treatment of fistulas arising from the third branchial cleft includes endoscopic cauterization or open cervical fistulectomy. Both approaches are associated with recurrence rates of 14%-18%, and possibly greater rates when the fistula has been treated operatively beforehand. Treatment of fistulas arising from the third branchial cleft is associated with an inordinate recurrence rate. Recurrence may be multifactorial and related to incomplete resection of all of the anatomical elements of the fistula.
To present a new approach that involves complete resection of the recurrent fistula by a combined therapeutic approach.
Here, 12 adult patients diagnosed with recurrent third branchial cleft fistulas underwent a combined therapy assisted by flexible fiber-optic pharyngoscopy to identify and resect the entry site of the fistula into the pyriform sinus. The fistulous opening into the pyriform sinus was identified by flexible fiber-optic pharyngoscopy. The application of intubation with a guidewire by pharyngoscopy, in addition to the removal of the partial excision of the thyroid cartilage, allowed complete resection of the opening and all parts of the fistula tract.
All of the internal openings of the fistulas in the pharynx were found and easily identified by flexible fiber-optic pharyngoscopy. All of the 12 patients underwent complete resection of the recurrent fistula by the combined therapeutic approach. There were no postoperative complications such as parapharyngeal abscess or wound infection, injury or dysfunction of the recurrent laryngeal or superior laryngeal nerves. The pharyngeal edema had degraded, and the pharyngeal wound healed postoperatively within 1 wk. Laryngeal endoscopy and voice analysis were performed on the 14th d post-operatively. Vocal cord movements did not change. The characters of voice for jitter, shimmer, and normalized noise energy were all within normal limits. In addition, no recurrences were observed during the 13-60 mo follow-up period.
It can be concluded that the proposed combined therapy is associated with excellent results, minimal morbidity, and no recurrence.
第三鳃裂瘘管的治疗方法包括内镜烧灼或开放性颈瘘切除术。两种方法的复发率均为14%-18%，如果瘘管此前接受过手术治疗，复发率可能更高。第三鳃裂瘘管的治疗复发率过高。复发可能是多因素的，与瘘管所有解剖结构未完全切除有关。
介绍一种通过联合治疗方法完全切除复发性瘘管的新方法。
12例诊断为复发性第三鳃裂瘘管的成年患者接受了联合治疗，在可弯曲纤维喉镜辅助下确定并切除瘘管进入梨状窝的入口部位。通过可弯曲纤维喉镜确定瘘管进入梨状窝的开口。除切除部分甲状软骨外，经喉镜应用导丝插管，可完全切除开口及瘘管的所有部分。
通过可弯曲纤维喉镜发现并轻松识别了所有瘘管在咽部的内口。12例患者均通过联合治疗方法完全切除了复发性瘘管。没有出现术后并发症，如咽旁脓肿或伤口感染、喉返神经或喉上神经损伤或功能障碍。咽部水肿消退，咽部伤口在术后1周内愈合。术后第14天进行了喉镜检查和嗓音分析。声带运动未改变。抖动、闪烁和归一化噪声能量等嗓音特征均在正常范围内。此外，在13-60个月的随访期内未观察到复发。
可以得出结论，所提出的联合治疗效果良好，发病率极低，且无复发。
