儿童第二鳃裂畸形18例分析

doi:10.11958/20260366

天津医药 ›› 2026, Vol. 54 ›› Issue (10): 1061-1064.doi: 10.11958/20260366

儿童第二鳃裂畸形18例分析

杨翠红(), 齐非凡, 郭智勇, 刘广平^△()

天津大学儿童医院/天津市儿童医院耳鼻喉科，天津市儿童出生缺陷防治重点实验室（邮编 300134）

收稿日期:2026-02-05 修回日期:2026-04-16 出版日期:2026-10-15 发布日期:2026-10-10
通讯作者: △E-mail：lgp414@163.com
作者简介:杨翠红（1986），女，主治医师，主要从事儿童头颈部疾病方面研究。E-mail：cuihongyang19@126.com
基金资助:
天津市医学重点学科建设项目(TJYXZDXK-3-016B)

Analysis of 18 cases of second branchial cleft anomalies in children

YANG Cuihong(), QI Feifan, GUO Zhiyong, LIU Guangping^△()

Department of Otolaryngology, Children's Hospital, Tianjin University / Tianjin Children's Hospital; Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin 300134, China

Received:2026-02-05 Revised:2026-04-16 Published:2026-10-15 Online:2026-10-10
Contact: △E-mail：lgp414@163.com

杨翠红, 齐非凡, 郭智勇, 刘广平. 儿童第二鳃裂畸形18例分析[J]. 天津医药, 2026, 54(10): 1061-1064.

YANG Cuihong, QI Feifan, GUO Zhiyong, LIU Guangping. Analysis of 18 cases of second branchial cleft anomalies in children[J]. Tianjin Medical Journal, 2026, 54(10): 1061-1064.

摘要/Abstract

摘要：

目的分析儿童第二鳃裂瘘管及囊肿的临床特点和诊疗方法，提高对第二鳃裂畸形（SBCA）的认识。方法回顾性分析2024年7月—2025年6月于天津市儿童医院行手术治疗的18例第二鳃裂畸形患儿的临床资料。所有患儿均在感染控制后接受全身麻醉下完整切除病变，Bailey Ⅳ型行高位结扎瘘管、不切除患侧扁桃体。术前均行MRI检查；术后3个月首次门诊复查颈部超声，此后每6个月~1年复查1次，记录患儿术后复发情况。结果 18例患儿中，男7例，女11例，年龄1~16岁，中位年龄5.5（3.0，11.0）岁。病程1~196个月，中位病程1.5（1.0，9.5）个月；均为单侧发病（左侧8例，右侧10例）；囊肿8例，瘘管10例；Bailey分型Ⅰ型6例、Ⅱ型6例、Ⅲ型4例、Ⅳ型2例。术前MRI检查示病变多表现为等长或稍长T₁、稍长或长T₂信号。均顺利完成手术，术中所见与术前MRI检查相符。术后未出现面瘫、声嘶、呛咳、舌体麻木、咽瘘等并发症。随访7~18个月，中位随访时间12（10，14）个月，未见复发。结论对于SBCA患儿，MRI在成像质量和安全性方面更具优势；瘘管高位结扎是预防复发的有效方法，无需同期切除患侧扁桃体。

关键词: 鳃原瘤, 儿童, 外科手术, 第二鳃裂畸形

Abstract:

Objective To analyze the clinical characteristics, diagnosis and treatment of children with second branchial cleft fistulas and cysts, and to improve the understanding of second branchial cleft anomalies (SBCA). Methods A retrospective analysis was performed on the clinical data of 18 children with SBCA who underwent surgical treatment at Tianjin Children's Hospital from July 2024 to June 2025. All children underwent complete resection of the lesion under general anesthesia after infection control. For Bailey type Ⅳ cases, high ligation of the fistula was performed without resection of the ipsilateral tonsil. All patients underwent preoperative MRI examination. The first follow-up cervical ultrasound was performed at 3 months postoperatively, followed by re-examination every 6 months to 1 year, and the postoperative recurrence was recorded. Results Among the 18 children, there were 7 boys and 11 girls, aged from 1 to 16 years, with a median age of 5.5 (3.0, 11.0) years. The disease course ranged from 1 to 196 months, with a median course of 1.5 (1.0, 9.5) months. All cases were unilateral, including 8 on the left side and 10 on the right side. There were 8 cases of cysts and 10 cases of fistulas. According to Bailey classification, there were 6 cases of type Ⅰ, 6 cases of type Ⅱ, 4 cases of type Ⅲ and 2 cases of type Ⅳ. Preoperative MRI showed that most lesions presented isointense or slightly hyperintense on T₁WI and slightly or markedly hyperintense on T₂WI. All operations were completed successfully, and the intraoperative findings were consistent with the preoperative MRI results. No postoperative complications such as facial palsy, hoarseness, choking, tongue numbness or pharyngeal fistula occurred after the operation. The patients were followed up for 7-18 months, with a median follow-up time of 12 (10, 14) months, and no recurrence was observed. Conclusion MRI has superior imaging quality and safety in the diagnosis of pediatric SBCA. High ligation of the fistula is an effective method to prevent recurrence, and simultaneous resection of the ipsilateral tonsil is unnecessary.

Key words: branchioma, child, surgical procedures, operative, second branchial cleft anomaly

中图分类号:

R726.53

图/表 2

图1 Bailey Ⅳ型SBCF颈部MRI影像患儿男，3岁。因“出生后发现右颈部小孔，右颈部反复感染1个月”，于2025年1月23日入院。小孔偶有黏稠分泌物溢出，无破溃及切开引流史。查体：右颈胸锁乳突肌前缘下方可见针尖样小孔，周围皮肤无红肿，吞咽时右颈部皮肤出现褶皱。MRI示甲状腺水平右侧颈前皮下线样病变，呈轻度强化；A为T1WI横断面，B为T1WI冠状面，C为T2WI矢状面。

Fig.1 Cervical MRI images of Bailey type Ⅳ SBCF

图2 Bailey Ⅰ型SBCF颈部CT和MRI影像患儿女，11岁。因“出生后发现右颈前小孔”，于2024年8月11日入院。小孔偶有淡黄色分泌物溢出伴异味，无感染史。查体：右侧胸锁乳突肌前缘中下交界处可见针尖样瘘口，其上方可触及约 1.0 cm×0.5 cm肿物，周围皮肤无红肿、压痛。A：Bailey Ⅰ型SBCF颈部CT影像可见右颈前皮下脂肪层内类圆形厚壁低密度结节；B、C为右侧颈前皮下脂肪层内小结节影，其中B为T1WI脂肪抑制序列横断面影像，C为T2WI脂肪抑制序列横断面影像。

Fig.2 Cervical CT and MRI images of Bailey type Ⅰ SBCF

参考文献 25

[1]	Lee D H, Yoon T M, Lee J K, et al. Clinical study of second branchial cleft anomalies[J]. J Craniofacial Surg, 2018, 29(6):e557-e560. doi:10.1097/SCS.0000000000004540.
[2]	Ghosh S K, Kr T, Datta S, et al. Parapharyngeal second branchial cyst:a case report[J]. Indian J Otolaryngol Head Neck Surg, 2006, 58(3):283-284. doi:10.1007/BF03050843.
[3]	Lau C Y, Wong H T. Branchial-cleft sinus manifesting as recurrent neck abscess[J]. N Engl J Med, 2018, 378(6):e9. doi:10.1056/NEJMicm1710539.
[4]	Bailey H. The clinical aspects of branchial fistulæ[J]. J Br Surg, 1933, 21(82):173-182.
[5]	Shen L F, Zhou S H, Chen Q Q, et al. Second branchial cleft anomalies in children:a literature review[J]. Pediatr Surg Int, 2018, 34(12):1251-1256. doi:10.1007/s00383-018-4348-8.
[6]	Ragab A, Hussein H A. Endoscopic combined transcervical-transoral second branchial fistulectomy:a novel technique with prospective case series[J]. Int J Pediatr Otorhinolaryngol, 2021, 145:110668. doi:10.1016/j.ijporl.2021.110668.
[7]	Kajosaari L, Mäkitie A, Salminen P, et al. Second branchial cleft fistulae:Patient characteristics and surgical outcome[J]. Int J Pediatr Otorhinolaryngol, 2014, 78(9):1503-1507. doi:10.1016/j.ijporl.2014.06.020.
[8]	陈伟, 徐蓉, 徐梦柔, 等. 儿童先天性第二鳃裂畸形38例诊治分析[J]. 中国耳鼻咽喉头颈外科, 2022, 29(4):263-267.
	Chen W, Xu R, Xu M R, et al. Diagnosis and treatment analysis of 38 cases of congenital second branchial cleft malformation in children[J]. Chin Arch Otolaryngol Head Neck Surg, 2022, 29(4):263-267. doi:10.16066/j.1672-7002.2022.04.015.
[9]	Kawaguchi M, Kato H, Aoki M, et al. CT and MR imaging findings of infection-free and benign second branchial cleft cysts[J]. Radiol Med, 2019, 124(3):199-205. doi:10.1007/s11547-018-0959-3.
[10]	Xian Z X, Chen Y C, Teng Y S, et al. Second branchial cleft cyst with snoring during sleep as initial symptom:a case report and literature review[J]. Medicine, 2021, 100(34):e27037. doi:10.1097/MD.0000000000027037.
[11]	Magdy E A, Hamza A, Youssef A, et al. Second branchial cleft fistula/sinus tract endoscopy:a novel intraoperative technique assisting complete surgical resection[J]. Eur Arch Oto Rhino Laryngol, 2021, 278(3):833-838. doi:10.1007/s00405-020-06158-6.
[12]	Patoulias I, Rachmani E, Farmakis K, et al. A bilateral,non-syndromic,type III second branchial arch sinus in a neonate:a case report[J]. Acta Medica (Hradec Kralove), 2018, 61(1):33-36. doi:10.14712/18059694.2018.21.
[13]	Piccioni M, Bottazzoli M, Nassif N, et al. Intraoperative use of fibrin glue dyed with methylene blue in surgery for branchial cleft anomalies[J]. Laryngoscope, 2016, 126(9):2147-2150. doi:10.1002/lary.25833.
[14]	Al Sukhun J, El Naggar M. Unusual presentation of a large multilocular second branchial cleft cyst[J]. J Craniofacial Surg, 2019, 30(6):1772-1773. doi:10.1097/SCS.0000000000005506.
[15]	Chen H. Atlas of genetic diagnosis and counseling[M]. 3rd ed. New York: Springer,2017:323-327.
[16]	王奥楠, 邬海博. 鳃裂瘘管的CT及MRI表现[J]. 实用放射学杂志, 2018, 34(4):515-517.
	Wang A N, Wu H B. CT and MRI findings of branchial cleft fistulas[J]. J Pract Radiol, 2018, 34(4):515-517. doi:10.3969/j.issn.1002-1671.2018.04.007.
[17]	何星辰, 张昌明, 杨润琴, 等. 罕见双外瘘口型第一鳃裂畸形1例[DB/OL]. 中国临床案例成果数据库(2022-02-24)[2026-01-25].
	He X C, Zhang C M, Yang R Q, et al. A case of rare first branchial cleft malformation with double external fistulas[DB/OL]. Chinese Clinical Case Repository(2022-02-24)[2026-01-25]. doi:10.3760/cma.j.cmcr.2022.e02231. http://journal.yiigle.com/LinkIn.do?linkin_type=cma&DOI=10.3760/cma.j.cmcr.2022.e02231.
[18]	Fanous A, Morcrette G, Fabre M, et al. Diagnostic approach to congenital cystic masses of the neck from a clinical and pathological perspective[J]. Dermatopathology, 2021, 8(3):342-358. doi:10.3390/dermatopathology8030039.
[19]	李秋菊, 李汝婷, 肖旭平, 等. 87例鳃裂畸形临床特征分析[J]. 中国耳鼻咽喉颅底外科杂志, 2024, 30(3):86-90.
	Li Q J, Li R T, Xiao X P, et al. Analysis of clinical features of 87 cases of branchial cleft malformation[J]. Chin J Otorhinolaryngol Skull Base Surg, 2024, 30(3):86-90. doi:10.11798/j.issn.1007-1520.202423194.
[20]	Mehmi N, Kumar R, Sagar P, et al. Importance and impact of appropriate radiology in the management of branchial cleft anomalies[J]. Indian J Otolaryngol Head Neck Surg, 2019, 71(1):953-959. doi:10.1007/s12070-019-01634-w.
[21]	王耀文, 谢奇伟, 程鹏, 等. 成人鳃裂畸形患者临床分析[J]. 中国耳鼻咽喉头颈外科, 2023, 30(8):527-528,532.
	Wang Y W, Xie Q W, Cheng P, et al. Clinical analysis of adult patients with branchial cleft malformations[J]. Chin Arch Otolaryngol Head Neck Surg, 2023, 30(8):527-528,532. doi:10.16066/j.1672-7002.2023.08.012.
[22]	刘颜彬, 杨彬, 王雪, 等. 鳃裂畸形159例临床分析[J]. 北京口腔医学, 2019, 27(4):221-224.
	Liu Y B, Yang B, Wang X, et al. Clinical analysis of 159 cases of branchial cleft malformations[J]. Beijing J Stomatol, 2019, 27(4):221-224.
[23]	Reddy A, Valika T, Maddalozzo J. Definitive surgical management for second branchial cleft fistula:a case series[J]. J Otolaryngol Head Neck Surg, 2020, 49:55. doi:10.1186/s40463-020-00453-2.
[24]	Kawami A, Goto Y, Nemoto Y, et al. A catheter-guided technique for second branchial cleft fistula excision in infants:a case report[J]. Surg Case Rep, 2025, 11(1):25-0013. doi:10.70352/scrj.cr.25-0013.
[25]	赵东吉慧, 李赟, 赵斯君, 等. 外瘘口切口入路内镜辅助下切除儿童先天性第一、二鳃裂畸形的疗效观察[J]. 临床耳鼻咽喉头颈外科杂志, 2025, 39(2):137-140,146.
	Zhao D J H, Li Y, Zhao S J, et al. Efficacy observation of endoscopic-assisted resection of congenital first and second branchial cleft malformations in children via external fistula incision approach[J]. J Clin Otorhinolaryngol Head Neck Surg, 2025, 39(2):137-140,146. doi:10.13201/j.issn.2096-7993.2025.02.008.

儿童第二鳃裂畸形18例分析

Analysis of 18 cases of second branchial cleft anomalies in children

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