Campbell Brett A, Kelly Zachary, Kim Hae-Young, Cunningham Michael Joseph, Choi Sukgi S
Department of Otolaryngology - Head and Neck Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.
Laryngoscope. 2025 Jul;135(7):2608-2616. doi: 10.1002/lary.32082. Epub 2025 Feb 20.
Recurrence is the primary complication of the Sistrunk procedure performed for the resection of thyroglossal duct cysts (TGDC). We aim to more confidently identify patients who may be predisposed to recurrence or other postoperative complications based on their clinical presentation and (or) perioperative course.
Our institution's electronic medical record was queried over a 23-year period (2000-2023) for patients with TGDC who underwent a Sistrunk procedure. Demographics, clinical presentation, and outcomes data were collected and analyzed. The primary outcome was the factors associated with postoperative TGDC recurrence. The secondary outcomes were the factors associated with Sistrunk procedure complications.
A total of 357 patients underwent a Sistrunk procedure for TGDC at a mean age of 5.75 years and an average duration of follow-up of 26.5 months. Age, gender, race, cutaneous tracts, tongue base findings, pre-operative infection, number of pre-operative infections, incision and drainage, needle aspiration, placement of a post-operative drain, and the type of drain placed were unassociated with recurrence. The two factors associated with recurrence were postoperative infection (adjusted OR = 11.98 [95% CI: 3.38, 42.49], p = < 0.001) and postoperative seroma (adjusted OR = 5.03 [95% CI: 1.17, 21.62], p = -0.030). Male sex was significantly associated with postoperative complications (adjusted OR = 3.26 [95% CI: 1.55, 6.89], p = 0.002).
Recurrence of TGDC after a Sistrunk procedure is an ongoing challenge that occurs in approximately 5% of cases. Recurrence is likely due to two factors: inadequate surgical technique and (or) histological factors like remnant arborizing microscopic ductules. Postoperative infection and seroma do not cause recurrence but may be predictors of residual disease due to one of these two factors and warrant closer surveillance.
复发是为切除甲状舌管囊肿（TGDC）而进行的西斯特伦克手术的主要并发症。我们旨在更有把握地根据患者的临床表现和（或）围手术期过程，识别可能易复发或出现其他术后并发症的患者。
查询了我们机构23年期间（2000 - 2023年）接受西斯特伦克手术的TGDC患者的电子病历。收集并分析了人口统计学、临床表现和结局数据。主要结局是与术后TGDC复发相关的因素。次要结局是与西斯特伦克手术并发症相关的因素。
共有357例患者因TGDC接受了西斯特伦克手术，平均年龄5.75岁，平均随访时间26.5个月。年龄、性别、种族、皮瘘、舌根表现、术前感染、术前感染次数、切开引流、针吸、放置术后引流管以及引流管类型与复发无关。与复发相关的两个因素是术后感染（调整后OR = 11.98 [95% CI：3.38, 42.49]，p = < 0.001）和术后血清肿（调整后OR = 5.03 [95% CI：1.17, 21.62]，p = -0.030）。男性与术后并发症显著相关（调整后OR = 3.26 [95% CI：1.55, 6.89]，p = 0.002）。
西斯特伦克手术后TGDC复发是一个持续存在的挑战，约5%的病例会出现复发。复发可能归因于两个因素：手术技术不足和（或）组织学因素，如残留的分支状微小导管。术后感染和血清肿不会导致复发，但可能是由于这两个因素之一导致残留疾病的预测指标，需要密切监测。
