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새낭종 새동 새루에 대한 임상적 고찰

Other Titles
 Clinical observations of branchial cysts, sinuses and fistulas 
Issue Date
1977
Description
의학과/석사
Abstract
[한글] 새낭종, 새동, 새루는 새열기관으로 부터의 발생학적 원인을 가짐으로서 그렇게 이름지어졌다. 이제까지 많은 사람들에 의해 이새기형의 원인에 대한 설명이 시도되었으나 각각의 학설에 대해 충분한 증거가 결핍되어 있음이 지적되어 내려왔었다. 1789년 Hunczowskidp 의애 최초로 새낭종과 새동이 발표된 이래 1832년 Von Ascherson은 이 새기형이 새열의 폐쇄나 소실의 결핍으로 유래된다고 결론지었다. 반면 Wenglowski는 1912년 새로운 thymo-Pharyngeal duct hrpothesis를 발전시켰고 최근에 King은 발생기간중 임파조직이나 임파선내에 상피세포가 남아있게 됨으로서 새낭종이 생겨나게 된다고 주장하였으며 1959년 Bhaskar와 Bernier는 광범위한 병리조직학적 연구를 통해 이를 증명하고 새낭종과 새동군 사이의 뚜렷한 차이점을 구별하였다. 저자는 1965년 부터 1976년 까지 만12년동안 연세의료원에서 새낭종, 새동, 새루로 입원하여 치료받은 55예외 환자를 대상으로 임상적소견, 치료방법, 가능성있는 발생학적 기원 등에 대해 고찰하여 다음과 같은 결과를 얻었다. 1. 발생빈도는 전이부 새동, 측경부 낭종, 측경부 새동군, 전이부 낭종의 순이었다. 2. 전이부 낭종군과 측경부 새동군에서 여자가 남자보다 3배 많았다. 3. 측경부 새동군에서 좌측이 2.7배 많았으며 양측성은 총괄 6%였다. 4. 전이부 기형과 측경부 새동군은 출생시나 출생직후에 나타났으며 측경부낭종군은 10대와 20대에서 최대빈도를 보여 평균발생연령은 16.7세 였다. 5. 대부분의 전이부 새동군은 귀의 crus of helix의 전면에 작은 개구부가 있었다. 6. 측경부 낭종의 대부분은 목의 윗쪽 1/3부위에 Sternocleidomastoid muscledml 앞쪽경계를 따라 존재했었다. 7. 측경부 동로의 외측개구부는 목의 아랫쪽 1/3 부위에 존재했었고 항상 내경동맥과 외경동맥의 사이를 지나 완전새루인 경우 인두의 편도상와에 일정하게 내측개구부가 열리고 있었다. 8. 흔히 급성감염성질환과 동반되어 낭종군에서 특히 빈번했다. 9. 동반된 선천성 기형은 구순열 1예, 소이중 1예, 부이종 1예였다. 10. 결핵성임파선염이나 갑상설간관낭종으로 오진하기 쉬우며 특히 측경부 낭종에서는 47%에서 오진하고 있었다. 11. 단순절개나 사다리식절개술로 낭종이나 동로를 완전히 제거할 수 있었다. 12. 창상감염 이외의 별다른 합병증은 없었다. 13. 동로의 대부분은 원주상피세포로 되어있었고 낭종과 동로의 외측개구부는 편평상피세포로 되어 있었다. 임파결절은 낭종이나 동로의 모두에서 상피층 밑에 존재했었다. CLINICAL OBSERVATIONS OF BRANCHIAL CYSTS, SINUSES AND FISTULAS Kwan Chul Tark, M.D. Department of Medical Science The Graduate School Yonsei University (Directed by Professor Choon Kyn Kim, M.D.) Branchial cysts, sinuses and fistulas were so named because of their supposed embryologic derivation from the branchial arches. Although the explanation of their origin has been handed down in the literature and texts for many years, there was not great deal of evidence to support this hypothesis. Branchial cysts and sinuses have been of interest ever since they were first reported by Hunczowski in 1789. However, all discussions of the embryological origin of anomalies in the lateral neck regions were dated to the publication, in 1832, of studies by von Ascherson of all the cases of lateral cervical anomalies available at that times. His conclusion was that these lesions resulted from failure of closure or obliteration of the branchial clefts. In 19l2, Wenglowski reinvestigated and concluded that branchial cysts arose from the remnants of the thymic duct. But this theory has been reputed by many as untenable although Meyer agreed with him. More recently King (1949) believed that it would be better to name these cysts according to their anatomical position or pathologic entity, such as, lateral lympho-epithelial cysts of the neck. In 1959, Bhaskar and Bernier reviewed the histologic features of 468 cases and concluded that these cysts arise from epithelial inclusions in lymph nodes. Although it is not the purpose of this paper to discuss at any great length the possible embryologic development of branchial cysts and sinuses, believing that the long time usage of the terms "Branchial cysts and fistulas" makes them permanent in our literature, thess two conditions were considered seperately because of significant differences in the history and objective findings, Author reviewed the patients with branchial cysts, sinuses and fistulas who were admitted and treated in Yonsei Medical Center during the period between 1965 and 1976 and evaluated clinical patterns, proper management and discussed possible embryologic origin. There have been 55 cases of branchial cysts, sinuses and fistulas in that period. The following results were obtained : 1. Incidence was ordered as follow: Preauriculer sinuses, Lateral cervical cysts, Lateral cervical sinus group, Preauricular cyst. 2. Females were affected 3 times more than males in preauricular cyst and lateral cervical situs group. 3. Left side was predominant in lateral cervical sinus group and bilateral involvement was overall 6%. 4. Preauricular lesions and lateral cervical sinuses were always evident at birth or just after birth. However, lateral cervical cysts were evident in 2nd and 3rd decade. The average age of onset for the lateral cervical cysts was 16.7 years. 5. Recurrence was higher in sinus group than cyst group in 2 to 4 times. 6. The presenting symptom in most of all the preauricular sinuses was small opening on crus of helix. 7. In most cases of the lateral cervical cyst, cyst mass was presented in the upper 1/3 of the neck along the anteromedial border of the Sternocleidomastoid muscle. 8. In most cases of the lateral cervical sinuses and complete fistulas, the cutaneous orifice was located in the lower one thirds of the neck, in reaching the pharynx, passed between the internal and external carotid artery. Internal openings were found uniformly in the region of the base of the supratonsillar fossa. 9. Usually combined with acute oro-pharyngeal infection, such as U.R.I., tonsillitis, sinusitis, caries especially in cyst group. 10. Combined congenital anomalies were cleft lip; 1 case, microtia; 1 case and accessory ear; 1 case. 11. Frequently mis-diagnosed as T.B. lymphadenitis or thyroglossal duct cyst especially in lateral cervical cysts. (47%) 12. Management was sufficient with complete excision of fistulous openings and tracts or cysts through single skin incision or two transverse incisions. 13. No specific complications except post-operative wound infections. 14. Microscopically the sinus tracts showed lining epithelium of columnar type throughout of the major portion. The cyst wall and distal extremity of the sinus tract revealed st. squamous epithelium. Lymphoid tissue was uniformly present beneath epithelial lining in either cyst and sinus tract
[영문] Branchial cysts, sinuses and fistulas were so named because of their supposed embryologic derivation from the branchial arches. Although the explanation of their origin has been handed down in the literature and texts for many years, there was not great deal of evidence to support this hypothesis. Branchial cysts and sinuses have been of interest ever since they were first reported by Hunczowski in 1789. However, all discussions of the embryological origin of anomalies in the lateral neck regions were dated to the publication, in 1832, of studies by von Ascherson of all the cases of lateral cervical anomalies available at that times. His conclusion was that these lesions resulted from failure of closure or obliteration of the branchial clefts. In 19l2, Wenglowski reinvestigated and concluded that branchial cysts arose from the remnants of the thymic duct. But this theory has been reputed by many as untenable although Meyer agreed with him. More recently King (1949) believed that it would be better to name these cysts according to their anatomical position or pathologic entity, such as, lateral lympho-epithelial cysts of the neck. In 1959, Bhaskar and Bernier reviewed the histologic features of 468 cases and concluded that these cysts arise from epithelial inclusions in lymph nodes. Although it is not the purpose of this paper to discuss at any great length the possible embryologic development of branchial cysts and sinuses, believing that the long time usage of the terms "Branchial cysts and fistulas" makes them permanent in our literature, thess two conditions were considered seperately because of significant differences in the history and objective findings, Author reviewed the patients with branchial cysts, sinuses and fistulas who were admitted and treated in Yonsei Medical Center during the period between 1965 and 1976 and evaluated clinical patterns, proper management and discussed possible embryologic origin. There have been 55 cases of branchial cysts, sinuses and fistulas in that period. The following results were obtained : 1. Incidence was ordered as follow: Preauriculer sinuses, Lateral cervical cysts, Lateral cervical sinus group, Preauricular cyst. 2. Females were affected 3 times more than males in preauricular cyst and lateral cervical situs group. 3. Left side was predominant in lateral cervical sinus group and bilateral involvement was overall 6%. 4. Preauricular lesions and lateral cervical sinuses were always evident at birth or just after birth. However, lateral cervical cysts were evident in 2nd and 3rd decade. The average age of onset for the lateral cervical cysts was 16.7 years. 5. Recurrence was higher in sinus group than cyst group in 2 to 4 times. 6. The presenting symptom in most of all the preauricular sinuses was small opening on crus of helix. 7. In most cases of the lateral cervical cyst, cyst mass was presented in the upper 1/3 of the neck along the anteromedial border of the Sternocleidomastoid muscle. 8. In most cases of the lateral cervical sinuses and complete fistulas, the cutaneous orifice was located in the lower one thirds of the neck, in reaching the pharynx, passed between the internal and external carotid artery. Internal openings were found uniformly in the region of the base of the supratonsillar fossa. 9. Usually combined with acute oro-pharyngeal infection, such as U.R.I., tonsillitis, sinusitis, caries especially in cyst group. 10. Combined congenital anomalies were cleft lip; 1 case, microtia; 1 case and accessory ear; 1 case. 11. Frequently mis-diagnosed as T.B. lymphadenitis or thyroglossal duct cyst especially in lateral cervical cysts. (47%) 12. Management was sufficient with complete excision of fistulous openings and tracts or cysts through single skin incision or two transverse incisions. 13. No specific complications except post-operative wound infections. 14. Microscopically the sinus tracts showed lining epithelium of columnar type throughout of the major portion. The cyst wall and distal extremity of the sinus tract revealed st. squamous epithelium. Lymphoid tissue was uniformly present beneath epithelial lining in either cyst and sinus tract
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http://ir.ymlib.yonsei.ac.kr/handle/22282913/117283
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2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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