儿童甲状舌管囊肿或瘘管术后复发的临床分析

Clinical analysis of postoperative recurrence of thyroglossal canal cysts or fistulas in children

摘要:

目的 探讨儿童甲状舌管囊肿或瘘管术后复发的临床特点和复发因素。方法 采集苏州大学附属儿童医院2015年7月—2024年7月收治的14例复发性甲状舌管囊肿或瘘管患者的临床资料，分析其临床特点和复发因素。本组患者男8例，女6例；年龄3岁9个月至8岁7个月，平均年龄5岁9个月。初次手术后复发时间为7个月至6年，平均17个月。结果 50%(7例)切口附近再次发现囊肿，35.7%(5例)切口处反复感染形成瘘管，7.1%(1例)患者出现睡眠打鼾，7.1%(1例)无临床症状。85.7%(12例)囊肿或瘘管和舌骨体相连，14.3%(2例)舌内段囊肿复发。14例患者均接受了二次手术治疗，其中13例患者二次手术完整切除舌骨体及囊肿，1例舌甲状舌管囊肿患者采用支撑喉镜下切除囊肿。二次手术后随访6个月至6年，二次手术复发率21.4%(3/14例)，复发病例仍表现为舌内段囊肿残留。结论 舌骨体残留是甲状舌管囊肿复发的首要因素，其次是舌内段囊肿残留。完整切除舌骨体可能对减少复发有着重要意义。对于复发病例，手术时建议除完整切除舌骨体外，更应注意舌内段囊肿的扩大切除。

Abstract:

Objective To explore the clinical characteristics and recurrence factors of postoperative recurrence of thyroglossal canal cysts or fistulas in children.Methods We collected the clinical data of 14 patients with recurrent thyroglossal canal cysts or fistulas admitted to the Children’s Hospital Affiliated to Soochow University from July 2015 to July 2024, and analyzed their clinical characteristics and recurrence factors. There were 8 male patients and 6 female patients in this group. The age distribution is 3 years and 9 months to 8 years and 7 months, with an average age of 5 years and 9 months. The recurrence time after the initial surgery ranges from 7 months to 6 years, with an average of 17 months.Results Clinical manifestations of 14 patients, cysts were again near the incision in 50% (7 cases), infections repeated and formed fistulas near the incision site in 35.7% (5 cases), sleep snoring occurred in 7.1% (1 case), and no clinical symptoms was 7.1% (1 case). 85.7% (12 cases) of cysts or fistulas were connected to the hyoid bone, and 14.3% (2 cases) of tongue intrasegment cysts recurred. All 14 patients underwent renovation secondary surgical treatment. Among the 14 patients, 13 cases underwent complete resection of the hyoid bone body and cyst in the second operation, while 1 case with lingual thyroglossal canal cyst underwent cystectomy under self-retaining laryngoscope. Follow up for 6 months to 6 years after the second operation showed a recurrence rate of 21.4% (3/14 cases). Recurrent cases still present with residual cysts in the intralingual segment.Conclusion Residual hyoid bone is the primary factor for the recurrence of thyroglossal canal cysts, followed by the recurrence of residual lingual intrasegment cysts. Complete removal of the hyoid bone may have significant implications for reducing recurrence. For recurrent cases, during renovation surgery, it is recommended to not only completely remove the hyoid bone, but also pay more attention to the extended resection of the intralingual cyst.