Закономірності перебігу ранового процесу після видалення бічних кіст шиї в дітей

Abstract

Проведено клінічне спостереження за 26 пацієнтами з різними видами бокових кіст шиї, які в переважній кількості (84,6%) розташовувалися в середній третині її бокової поверхні, а у 80,7% спостережень займали місце попереду кивального м’яза. Досить високу діагностичну інформативність мають ультразвукове дослідження й пункційна біопсія утвору, які в складних і сумнівних випадках дозволяють віддиференціювати нозологічну форму захворювання. У післяопераційний період для визначення фазності перебігу ранового процесу і своєчасного виявлення ранніх ознак запалення з успіхом можуть бути застосовані вивчення клітинного складу ранового ексудату й контактна термометрія тканин навколо рани, що дозволяє, за необхідності, своєчасно внести корективи в лікувальну тактику й особливості ведення хворих у післяопераційний період.

The course of the wound healing process after surgical intervention on brancial cleft cyst excision should be considered as a stereotyped inflammatory-reparative reaction of the body, characterized by staged aseptic inflammation, regeneration and fibrosis. Clinically and even morphologically, it is difficult to determine the stages of the wound healing process in the temporal aspect, since they are consistent and interconnected. Purpose. The paper is aimed at evaluation of the wound healing process according to clinical indicators in children after branchial cleft cyst excision. Methods and Material. 26 children aged from 5 to 17 years old with branchial cleft cysts have been examined and treated. In the postoperative period, the nature, amount of exudate and its cell composition has been determined; skin contact thermometry has been performed at 4 points around the wound at a distance of 1 cm. Results. The first manifestations of the disease coincided with the course of acute respiratory viral diseases in 8 children (30.8%); association with ENT pathology was observed in 3 (11.5%) children and the cystic masses emerged spontaneously in 15 cases (57.7%). They were localized with almost the same incidence on the left and right, but the vast majority (21 cases (80.7%)) was located anteriorly the sternocleidomastoid muscle and in 5 (19.3%) cases behind it. Ultrasound examination, made in 21 patients (80.8%), has revealed the presence of cystic masses with clear contours, hypoechoic structure and fine-grained inclusions, and the wall thickness varied from 1 to 3 mm. In 5 doubtful cases (19.2%) a puncture biopsy was performed. On 1st day after surgery, hyperemia around the wound was moderate in 15 children (57.7%); it was insignificant in 8 (30.8%) children and it was absent in 3 (11.5%) children. At the same time all children experienced collateral edema of various localization and painful modality. In the impression smears, a significant number of neutrophils, a moderate number of lymphocytes and erythrocytes was detected, which were prominent against the background of a loose substrate. The temperature of the wound area was 36.24 ± 0.07˚C, which was higher compared to the control group (34.71 ± 0.12˚C). On 3rd day, the corolla of hyperemia around the wound was not detected in 18 patients (69.2%), and its narrowing was recorded in 6 (23.1%) cases and it was persistent in 2 (7.7%) cases. On palpation, severe, moderate and weak pain on the wound area was experienced by 2 (7.7%), 15 (57.7%) and 9 (36.4%) children, respectively. The cytograms of the exudate showed a reduced quantity of neutrophils, erythrocytes and lymphocytes. Two children showed elevated quantity of destructured neutrophils and local temperature to 37.21 ± 0.16 ° C, which required medical adjustments. A narrow corolla of hyperemia around the wound, slight edema and moderate pain was detected on 7th day only in 2 children. In all patients, palpation revealed tissue compaction along the wound canal, onset of epithelialization, and the cytograms revealed the presence of sporadic neutrophils. The temperature of the skin around the wound reached 35.74 ± 0.11˚C, which was almost similar to controls (34.21 ± 0.08˚C). In all cases, the wounds healed with primary tension. Thus, the nature of the dynamics of wound healing after brancial cleft cyst extirpation in children can be successfully controlled by the prominence of the main clinical signs, the findings of the study of cellular composition of wound exudate and local temperature measuring. The perspectives of further research are associated with availability and simplicity of the methods in terms of their application in everyday clinical practice.