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摘要: 目的 探讨儿童先天性耳前瘘管个体化手术方式的疗效及影响因素。方法 回顾性分析2016年7月—2020年12月福建医科大学附属福州儿童医院耳鼻咽喉科收治的98例(109耳)先天性耳前瘘管患儿的临床资料，根据瘘管特点及感染控制情况分为普通型与变异型、炎症静止期与感染局限期，分别采用经典瘘管切除法、双梭形切口法、瘘口定位切除法等个体化手术方式，分析不同手术方式的疗效、并发症及影响因素。结果 除经典瘘管切除法的手术时间较双梭形切口法、瘘口定位切除法明显缩短，差异有统计学意义(t分别为-2.905、-3.005，均P＜0.05)外，三种手术方式均取得较好的疗效，切口并发症、瘘管复发等的差异均无统计学意义(均P＞0.05)。结论 先天性耳前瘘管一旦出现感染，应在感染完全控制或最大化控制后早期手术。手术方式应个体化，彻底切除瘘管及病灶的同时兼顾微创及美观。Abstract: Objective To investigate the effect and influencing factors of individualized operation for congenital preauricular fistula in children.Methods The clinical data of 98 cases (109 ears) of congenital preauricular fistula treated in Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Medical University from July 2016 to December 2020 were retrospectively analyzed. According to the characteristics and infection of preauricular fistula, they were divided into common type and variant type, static period of inflammation and period of infection.Individual surgical methods such as classical fistula resection, double fusiform incision and fistula location resection were used respectively.The efficacy, complication and influencing factors of different surgical methods were analyzed.Results The operation time of classical fistula resection was shorter, and the difference was statistically significant(t = －2.905 and－3.005 respectively, all P < 0.05). According to the stages and types of fistulas, the selection of individualized surgical methods had achieved good results. There was no significant difference in incision complications and fistula recurrence among different surgical methods (all P > 0.05).Conclusion Once infection occurs in congenital preauricular fistula, surgical resection should be performed as soon as possible after infection control, or as early as possible after infection maximum control if infection cannot completely subside. Surgical incision design should be individualized, complete resection of fistulas and lesions, minimally invasive and aesthetic.
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Key words:
- congenital preauricular fistula /
- child /
- surgical procedures, operative /
- individuation
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图 1 先天性耳前瘘管分型 1a：普通型；1b：变异型，“黑色箭头”示耳轮脚有2个瘘口； 图 2 炎症静止期瘘管及手术切口 2a：瘘口前下方见陈旧性瘢痕愈合；2b：瘘管走行示意图，自瘘口向深部延伸，走行不一，多在耳轮脚前方聚集成团，并与耳廓软骨粘连；2c：经典瘘管切除法术后切口； 图 3 感染局限期瘘管及手术切口 3a：瘘口前下方见局限性感染灶；3b：瘘管走行示意图，自瘘口向前下方的局限性感染灶延伸；3c：双梭形切口法设计的切口；3d：双梭形切口法术后切口； 图 4 变异型瘘管及手术切口 4a～4c：瘘管走行示意图，耳轮脚前及耳轮脚分别有一瘘口，二者之间不相通(4a)或通过穿透耳廓软骨的瘘管相通(4b)；耳轮脚前及耳后沟处分别有一瘘口，二者之间有穿透耳廓软骨的瘘管相通(4c)；4d：瘘口定位切除法术后切口，黑色箭头示切口分别位于耳轮脚及耳后沟。
表 1 不同手术方式的疗效及术后并发症比较
耳(%) 手术方式 耳数 手术时间/min 切口 疗效 一期愈合 并发症 痊愈 瘘管复发 经典瘘管切除法 88 22.3±4.0 83(94.3) 5(5.7) 87(98.9) 1(1.1) 双梭形切口法 3 31.0±1.7 2(66.7) 1(33.3) 3(100.0) 0(0) 瘘口定位切除法 18 31.7±10.4 16(88.9) 2(11.1) 17(94.4) 1(5.6) χ2(F) 15.126 3.679 1.662 P值 ＜0.05 0.159 0.436 
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表 2 术后切口并发症相关影响因素分析
并发症 耳数 术前感染史 术前切开排脓史 瘘管穿入/穿透软骨 术区瘢痕增生 手术时间/min 无 101 82(81.2) 68(67.3) 85(84.2) 87(86.1) 25.4±6.1 有 8 7(87.5) 6(75.0) 8(100.0) 7(87.5) 29.5±6.1 χ2(t) 0.197 0.200 1.485 0.012 -1.833 P值 0.657 0.655 0.223 0.914 0.070
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