【摘要】：目的:探討感染性先天性耳前瘺管的病理組織學(xué)特點(diǎn),為降低術(shù)后復(fù)發(fā)率、改進(jìn)手術(shù)方法提供依據(jù)。方法:收集感染性耳前瘺管患者25例,其中有感染史非感染期患者14例,處于感染期患者9例,術(shù)后復(fù)發(fā)再手術(shù)者2例。手術(shù)時(shí)整塊切除瘺管組織及瘢痕組織。觀察分析手術(shù)標(biāo)本并行連續(xù)病理切片。結(jié)果:1大體形態(tài):有感染史非感染期的手術(shù)標(biāo)本近端為瘺管組織,保持瘺管原有形態(tài),中遠(yuǎn)端為暗紅色實(shí)性瘢痕組織;處于感染期的手術(shù)標(biāo)本近端為瘺管組織,遠(yuǎn)端為肉芽組織和瘢痕組織包繞形成的膿腔,瘺管與膿腔不相交通;術(shù)后復(fù)發(fā)的標(biāo)本為多囊性腫物,呈典型的啞鈴狀外觀。2組織學(xué)觀察:有感染史非感染期者和術(shù)后復(fù)發(fā)者鏡下可見瘺管遠(yuǎn)端走行不連續(xù),呈多個(gè)束狀管腔,管腔之間被條索狀纖維組織分隔;處于感染期者鏡下除上述表現(xiàn)外,膿腔周圍可見新生的毛細(xì)血管及漿細(xì)胞、淋巴細(xì)胞和中性粒細(xì)胞浸潤(rùn)。3隨訪6~12個(gè)月,無(wú)復(fù)發(fā)。結(jié)論:感染性先天性耳前瘺管組織被瘢痕組織分隔為多段,互不相通,瘺管內(nèi)注射美藍(lán)等示蹤劑無(wú)法完整顯示瘺管的走行,故單純依靠示蹤劑切除瘺管易致殘留。整塊切除瘺管組織及瘢痕組織是防止瘺管上皮殘留的有效手段,可降低術(shù)后復(fù)發(fā)率。
文內(nèi)圖片：
圖片說明：可見切開引流口；圖４～６肉眼觀察完整病理切片（黑箭頭：瘺管口；白箭頭：引流口；
[Abstract]:Objective: to investigate the pathological characteristics of infectious congenital preauricular fistula, and to provide evidence for reducing the recurrence rate and improving the surgical method. Methods: twenty-five patients with infectious preauricular fistula were collected, including 14 patients with history of infection in non-infectious stage, 9 patients in infectious stage and 2 patients with recurrent and reoperation after operation. The fistula tissue and scar tissue were resected as a whole during the operation. The surgical specimens were observed and analyzed with continuous pathological sections. Results: 1 Gross morphology: the proximal end of the surgical specimen with a history of infection was the fistula tissue, maintaining the original shape of the fistula, the middle and distal end of the operation specimen was dark red solid scar tissue, the proximal end of the surgical specimen was the fistula tissue, the distal end was the pus cavity surrounded by granulation tissue and scar tissue, and there was no communication between the fistula and the pus cavity. The recurrent specimens were polycystic masses with a typical dumbbell appearance. 2 histologic observation: under microscope, the distal end of the fistula was discontinuity, showing multiple bundles of lumen, separated by striped fiber tissue between the patients with a history of infection in the non-infected phase and the recurrence after operation. In addition to the above findings, neonatal capillaries and plasma cells, lymphocytes and neutrophils were infiltrated around the pus cavity. 3 follow-up for 6 to 12 months showed no recurrence. Conclusion: infectious congenital preauricular fistula tissue is divided into many segments by scar tissue, which is not connected with each other. The injection of methylene blue into the fistula can not completely show the course of the fistula, so it is easy to cause residual after resection of the fistula with tracer alone. Whole resection of fistula tissue and scar tissue is an effective method to prevent fistula epithelial residue, which can reduce the recurrence rate after operation.
【作者單位】： 大連大學(xué)附屬中山醫(yī)院耳鼻咽喉科;
【分類號(hào)】：R764

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