华西医学

华西医学

儿童第一鳃裂畸形术中耳大神经的保护

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目的探索儿童第一鳃裂畸形术中保护耳大神经的可行性。方法对 2005 年 9 月—2015 年 5 月入住四川大学华西医院的 17 例第一鳃裂囊肿、瘘管或窦道患儿进行回顾性分析。术前用 CT 增强扫描确认病变范围。结合影像学及随后的术中探查,无 1 例患儿累及中耳乳突。术中解剖保护耳大神经部分分支,完整切除瘘管、窦道或囊肿,保留腮腺组织或行部分腮腺切除术。术后随访 6 个月~3 年,平均 2 年 1 个月。结果所有患儿无复发或术后面瘫发生。12 例患儿无明显耳大神经支配区感觉异常,5 例患儿有耳垂或耳廓下 1/3 区域感觉减退。结论儿童第一鳃裂畸形切除术中保护部分耳大神经分支是可行的,不影响手术对于病灶的彻底切除,有助于提高患儿生活质量。

ObjectiveTo explore the feasibility to protect great auricular nerve during surgery for first branchial cleft anomaly in children.MethodsThe data of 17 cases of first branchial cleft cyst, sinus or fistula admitted to West China Hospital of Sichuan University from September 2005 to May 2015 were reviewed. The extent of lesion was demonstrated by enhanced CT before operation. Later surgery further proved that the middle ear and mastoid process was not involved in any of the cases. During surgery, some branches of great auricular nerve were dissected and spared. The cyst, sinus or fistula was obliterated completely while the whole or part of the parotid gland was preserved. The patients were followed-up from half a year to three years with mean time of 2 years and 1 month.ResultsNo recurrence or facial paralysis were found in all patients after surgery. Twelve patients had no paresthesia in the area innervated by great auricular nerve, five patients experienced numbness of ear lobe or inferior 1/3 of the auricle.ConclusionIt is feasible to protect some branches of great auricular nerve during the operation for first branchial cleft anomaly, which does not hinder the thoroughness of the resection for the lesion, and helps to improve the children’s quality of life.

关键词: 第一鳃裂畸形; 耳大神经; 手术; 功能; 保护

Key words: First brachial cleft anomaly; Great auricular nerve; Surgery; Function; Protection

引用本文: 陈敏, 郑美君, 李文, 陈玥竹, 杨柳. 儿童第一鳃裂畸形术中耳大神经的保护. 华西医学, 2018, 33(3): 321-324. doi: 10.7507/1002-0179.201704191 复制

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