| 711 | 19 | 30 |
| 下载次数 | 被引频次 | 阅读次数 |
目的探讨感染耳前瘘管的临床特征及有效手术治疗方法;方法总结分析154例165侧感染耳前瘘管的临床表现特征;采用广泛局部切除法切除瘘口、瘘管、感染灶及相关耳廓软骨;需要时酌情选用适合的皮瓣修复缺损。结果普通型耳前瘘管142例153侧,瘘口在外耳道口前上方区域;变异型耳前瘘管共12例/侧,分别开口于耳轮脚、外耳道内、耳廓后上方。感染可发生在瘘口(管)周围任何部位,感染程度可表现为红肿硬结、肿胀渗出、脓肿形成、局部溃破(切开)及炎症疤痕等。术后随访6-36个月,无失访,复发共5例/侧,占3.03%(5/165侧),其中变异型1例/侧,普通型4例/侧,差异无显著性(c2=1.239, P=0.266),其余患者均治愈。用皮瓣修复的患者15例均一期愈合。结论感染耳前瘘管临床表现多种多样;手术切除是治疗感染耳瘘的有效方法,掌握感染耳前瘘管基本知识、保证完整彻底的病灶切除,是减少或避免复发的基本前提。
Abstract：Objective To report clinical characteristics and surgical treatment of infected preauricular fistula.Methods Clinical features of infected preauricular fistula in 154 cases(165 sites) were reviewed. All patients underwent wide local excision to remove fistula pening and tracts of preauricular together with part of helix cartilage and inflamed tissues. Appropriate flaps were used to repair defects when necessary. Results Classical preauricular fistulas were found in 142 of the 153 sites, with variant types of preauricular sinus in 12 cases/sites. Infection of various degrees manifested as red induration, swelling, exudation, abscess, ulceration(drainage), inflammatory scars et al. All patients were followup for 6-36 months after operation, with recurrence developing in 5 cases/sites(3.03%),in which the variant type was 1 case/side,and classical type were 4 cases/side. the difference was no significant(c2=1.239, P=0.266), the other patients were cured. Repair using flaps was successful in all 15 patients with indicatios. Conclusion Clinical features of infected preauricular fistula are variable. Surgical resection is the effective treatment and complete excision of the primary lesion is critical to prevent recurrence.
1 Pang J,Xiong H,Liao Q,et al.The diagnosis and treatment of a variant type of auricular sinus:postauricular sinus[J].Eur Arch Otorhinolaryngol,2019,276(7):1961-1967.
2 Choi SJ,Choung YH,Park K,et al.The variant type of preauricular sinus:postauricular sinus[J].Laryngoscope,2007,117(10):1798-802.
3 Rakhi K,Rajiv KJ,Priyanko C,et al.Fistular Opening below the Inter‐tragric Notch:A Rare Variant of Pre-Auricular Sinus[J].J Clin Diagn Res,2016,10(9):MJ01-MJ02.
4 Mohammad WE,Ahmed SE.Supra-auricular versus Sinusectomy Ap‐proaches for Preauricular Sinuses[J].Int Arch Otorhinolaryngol,2016,20(4):390-393.
5 Marom T,Goldfarb A,Roth Y.Intra-auricular sinus:first description of a variant of the pre-auricular cyst[J].J Craniofac Surg,2013,24(1):e12-3.
6 Kavuturu VS,Kumar C,Nelakurthi SC,et al,Preauricular sinus:a novel approach[J].Indian J Otolaryngol Head Neck Surg,2013,65(3):234-236.
7 Bruijnzeel H,van d A,Grolman W,et al.A systematic review on the surgi‐cal outcome of preauricular sinus excision techniques[J].Laryngoscope,2016,126(7):1535-44.
8 Yoo H,Park DH,Lee J,et al.A surgical technique for congenital preauricu‐lar sinus[J].Arch Craniofac Surg,2015,16(2):63-66.
9 Chan KC,Kuo HT,Chuang WY,et al.A modified supra-auricular ap‐proach with helix cartilage suture for surgical treatment of the preauricular sinus[J].Int J Pediatr Otorhinolaryngol,2018,114(1):147-152.
10 Kim HJ,Lee JH,Cho HS,et al.A case of bilateral postauricular sinuses[J].Korean J Audiol,2012,16(1):99-101.
11 Choo OS,Kim T,Jang JH,et al.The clinical efficacy of early intervention for infected preauricular sinus[J].Int J Pediatr Otorhinolaryngol,2017,95(1):45-50.
12 Heusinger HK.Fisteln von Noch Nicht Beobachteter Form[J].Virchows Arch,1864,29:358.
13周萍,陈金辉,黄婷,等.先天性耳前瘘管的研究进展[J].临床耳鼻咽喉头颈外科杂志,2019,33(5):474-476.Zhou P,Chang QH,Huang T,et al.Research progress of congenital preauricular fistula[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2019,33(5):474-476.
14 An SY,Chio HG,Lee JS,et al.Analysis of incidence and genetic predispo‐sition of preauricular sinus[J].Int J Pediatr Otofhinolaryngol,2014,78(12):2255-2257.
15 Wang L,Wei L,Lu W,et al.Excision of preauricular sinus with abscess drainage in children[J].Am J Otolaryngol,2019,40(2):257-259.
16 Gan EC,Anicete R,Tan HK,et al.Preauricular sinuses in the pediatric population:techniques and recurrence rates[J].Int J Pediatr Otorhinolaryn‐gol,2013,77(3):372-8.
17 Huang WJ,Chu CH,Wang MC,et al.Decision making in the choice of sur‐gical management for preauricular sinuses with different severities[J].Oto‐laryngol Head Neck Surg.2013,148(6):959-964.
18 Kim JR,Kim DH,Kong SK,et al.Congenital periauricular fistulas:possi‐ble variants of the preauricular sinus[J].Int J Pediatr Otorhinolaryngol,2014,78(11):1843-8.
19 Dutta M,Ghatak S,Sarkar R.Of periauricular pits and sinuses:understand‐ing the masqueraders[J].Einstein.2014,12(1):132-33.
20王志远,赵海,姜美妍,等.47例感染性先天性耳前瘘管患者分泌物细菌培养及药敏学分析[J].中华耳科学杂志,2018,16(4):543-547.Wang ZY,Zhao H,Jiang MY,et al.Exudate culture and drug sensitivity test results in 47 patients with infected congenital pre-auricular fistulas[J].Chinese Journal of Otology,2018,16(4):543-547.
21 Kim WJ,Lee YM,Kim DH,et al.Causes and prevention of revision sur‐gery for preauricular sinus:A histopathological analysis[J].Int J Pediatr Otorhinolaryngol,2019,116(1):199-203.
22王英歌,阳菊华,张榕,等.先天性耳前瘘管的遗传与临床特征分析[J].中华耳科学杂志,2015,13(4):650-653.Wang YG,Yang JH,Zhang R,et al.Inheritance and clinical characteristics of congenital preauricular fistula[J].Chinese Journal of Otology,2015,13(4):650-653.
基本信息:
中图分类号:R764.9
引用信息:
[1]韦明壮,罗绮宁,黄嘉韵,等.感染耳前瘘管的临床特征和手术治疗[J].中华耳科学杂志,2021,19(01):27-31.
2021-01-29
2021-01-29