Objective: To analyze the clinical characteristics and endoscopic surgical procedures of the second branchial cleft cyst type Ⅳ in children. Methods: A retrospective review was conducted on 15 pediatric cases with type Ⅳ second branchial cleft cysts treated at the Beijing Children's Hospital affiliated with Capital Medical University and Henan Children's Hospital from September 2019 to November 2023. All patients underwent excision via a two-person, three-hand endoscopic transoral approach. The cohort included 12 males and 3 females, with an age range of 10 months to 10 years and 5 months, and a median age of (59.20±32.05) months. The clinical data of initial symptoms, sides, imaging features, treatment methods, complications, length of hospital stay, prognosis and outcome were recorded and analyzed. SPSS 22.0 software was used for statistical analysis. Results: Of the 15 children, 13 cases presented with snoring as the primary symptom, 1 case with dysphagia, and 1 case was asymptomatic and was found unintentionally. The mean disease duration was (6.74±9.05) months (range, from 3 days-2 years). MRI revealed cystic lesions on the right side in 12 cases and on the left side in 3 cases, characterized by uniform long T2 signal, equal T1 or short T1 signal. The cysts appeared dumbbell-shaped in 10 cases with the pharyngeal constrictor muscle as the waist, the posterior outside of the mass was adjacent to the internal carotid artery. The remaining 5 cases showed an isolated cyst located inside the pharyngeal constrictor muscle. The intraoperative MRI findings were consistent. Partial cystectomy was performed in 10 cases near the internal carotid artery, leaving only the portion with a clear arterial pulse intact. Five cases with isolated cysts on the medial side of the pharyngeal constrictor muscle were totally removed. The average length of hospital stay was (4.53±0.52) days (4-5 days). All patients were followed up for 7-56 months [median (30±15.12) months] with no recurrence of symptoms observed. Conclusions: The second branchial cleft cyst type Ⅳ in children is characterized by prominent pharyngeal cystic mass, with snoring as a predominant initial symptom, MRI provides excellent diagnostic value. The two-person, third-hand endoscopic transoral approach for cyst excision is feasible, safe, and offers the benefits of minimal invasiveness and reduced hospitalization time.
目的： 分析儿童第2鳃裂囊肿Ⅳ型的临床特点及内镜手术方式。 方法： 回顾性分析2019年9月至2023年11月就诊于首都医科大学附属北京儿童医院及河南省儿童医院郑州儿童医院耳鼻咽喉头颈外科的15例第2鳃裂囊肿Ⅳ型患者资料，其中男性12例，女性3例，年龄为10个月至10岁5个月［（59.20±32.05）个月］。采用两人三手经口内镜入路切除囊肿，记录并分析患者首发症状、侧别、影像学特征、治疗方式、并发症、住院时长、预后转归等相关临床资料。采用SPSS22.0软件进行统计学分析。 结果： 15例患儿中13例以睡眠打鼾为首发症状（13/15），1例表现为吞咽不畅，1例无临床症状为无意中发现，平均病史时间（6.74±9.05）个月（3 d~2年），其中右侧囊肿12例，左侧囊肿3例。MRI均呈囊性信号，表现为均匀的长T2信号，等T1或短T1信号不等，其中10例呈现为哑铃状，以咽缩肌为腰部，肿物后外界紧贴颈内动脉，5例表现为孤立的囊肿，位于咽缩肌内侧。手术均采用两人三手手持内镜经口入路下低温等离子操作，术中所见与MRI表现相符，10例紧贴颈内动脉囊肿予以大部分切除，仅保留紧贴颈内动脉、可及明显动脉性搏动部分；5例表现为咽缩肌内侧的孤立性囊肿，予以全切，病理均证实符合先天性鳃裂囊肿病理表现。术后第1天均可经口进半流食，住院时间（4.53±0.52）d，随访7~56个月，患儿症状均未见复发，颈部MRI或超声复查未见肿物复发。 结论： 儿童第2鳃裂囊肿Ⅳ型表现为咽部突出的囊性包块，多以睡眠打鼾为首发症状，MRI具有较好的诊断价值，采用两人三手内镜下经口入路手术对于囊肿切除具有可行性、安全性，并具有创伤小、住院时间短的优点。.