- 期刊
以組織病理學之觀點論耳前瘻管之處置
Management of Preauricular Fistulae - Viewing from Histopathology
摘要
背景：耳前廔管為一常見的先天異常。其成因是由於胚胎發生時，第一及第二鰓弓遠端6個耳丘（auricular hillocks）融合不完整所致。臨床上以傳統之手術方式不易精確定位廔管之延伸範圍，因而造成廔管切除不完全及復發之情形。本研究以病理切片之所見提出降低復發機率的手術原則。 方法：自1997年1月至1998年12月間於本科施行初次耳前廔管摘除術之病人共計37名，共47耳。手術方法以龍膽紫（gentian violet）注入廔管內，然後以新月形耳前切開，摘除廔管及其周圍組織。而與廔管底部相接觸之耳輪軟骨連同軟骨膜亦作片狀切除。術後將切除之廔管及一併切除之軟骨片病理切片檢查，以研究兩者間之關聯。 結果：所有37名病人不論有無感染經驗在其病理切片檢查中，皆可發現廔管之複層鱗狀上皮呈不規則狀深入周圍之纖維層組織，而纖維層組織與耳輪軟骨之軟骨膜緊緊相連幾乎無法在術中以肉眼分辨及剝離。所有37名病人中，術後至少6個月至2年的追蹤（平均16.8個月）只有1耳復發。 結論：由病理切片研究可知耳前廔管周圍纖維層確與其下耳輪軟骨膜相連，而欲完全剝離廔管纖維層與軟骨膜是相當困難的。廔管切除不完全是導致復發之主要原因，相較國外研究統計術後復發率約5%至42%不等，而本研究的手術方式之復發率為2.1%。因此在耳前廔管摘除術中一併切除其下相連軟骨以確保廔管完全摘除確有其必要。
並列摘要
BACKGROUND:Preauricular fistulae are common congenital anomalies. They result from the incomplete fusion of auricular hillocks derived from the first and second branchial arches. Recurrent infection is common if the excision of the fistulae is incomplete. In this study, we tried to excise the fistulae together with the adjacent cartilage. METHODS:From January 1997 to December 1998, we had 37 patients(47 ears) with preauricular fistulae who underwent surgical excision. The main procedure was as follows:An elliptical incision was made around the prestained fistula open-ing. Then the tract and surrounding tissues were excised, and then the helical carti-lage adjacent to the tract was also cut off. All specimens were sent for histopatho-logical study. RESULTS:The follow-up period ranged from 6 months to 2 years(average, 16.8 months). The histopathological examination revealed that the fibrotic tissues around the fistula tract usually firmly adhered to the cartilage in all specimens. Recurrent infection was found in only one case. CONCLUSIONS:Based on histopathological study, it is believed that complete dissection of the fibrotic tissues around the fistula tract from the perichondrium is not easy. Incomplete extirpation of preauricular fistulae may lead to recurrent infec-tion. It is suggested that the fistula tract should be excised together with the adja-cent cartilage in cases of preauricular fisulae.