尚无未经治疗的囊肿恶性转化的病例报道。
保守治疗
据报告,多达 58% 的囊肿观察到消退。[20]Dias JJ, Dhukaram V, Kumar P. The natural history of untreated dorsal wrist ganglia and patient reported outcome 6 years after intervention. J Hand Surg Eur Vol. 2007;32:502-508.http://www.ncbi.nlm.nih.gov/pubmed/17950209?tool=bestpractice.com 儿科患者的自行消退率更高,某些情况下,经过 9 到 12 个月的时间,自行消退率最高可达 93%。[21]Calif E, Stahl S, Stahl S. Simple wrist ganglia in children: a follow-up study. J Pediatr Orthop B. 2005;14:448-450.http://www.ncbi.nlm.nih.gov/pubmed/16200024?tool=bestpractice.com
囊肿穿刺和抽吸
若原手术失败,则可能需要多项治疗。据报告,背侧腱鞘囊肿穿刺的单次抽吸成功率为 13%。若此后将腕部通过夹板治疗 3 周,则该项手术的成功率可升至约 40%,而在多达 3 次治疗后,成功率会升至约 85%。[20]Dias JJ, Dhukaram V, Kumar P. The natural history of untreated dorsal wrist ganglia and patient reported outcome 6 years after intervention. J Hand Surg Eur Vol. 2007;32:502-508.http://www.ncbi.nlm.nih.gov/pubmed/17950209?tool=bestpractice.com[22]Richman JA, Gelberman RH, Engber WD, et al. Ganglions of the wrist and digits: results of treatment by aspiration and cyst wall puncture. J Hand Surg Am. 1987;12:1041-1043.http://www.ncbi.nlm.nih.gov/pubmed/3693833?tool=bestpractice.com[23]Zubowicz VN, Ishii CH. Management of ganglion cysts of the hand by simple aspiration. J Hand Surg Am. 1987;12:618-620.http://www.ncbi.nlm.nih.gov/pubmed/3611665?tool=bestpractice.com
手术切除
复发率各异,这取决于囊肿位置以及能否完全切除整个囊肿和柄(例如,有时腕掌侧囊肿十分贴近桡动脉,以致不可能实现完全切除)。
文献中,开放治疗后的腕背侧腱鞘囊肿复发率介于 3%~9%。[25]Mackie IG, Howard CB, Wilkins P. The dangers of sclerotherapy in the treatment of ganglia. J Hand Surg Br. 1984;9:181-184.http://www.ncbi.nlm.nih.gov/pubmed/6747425?tool=bestpractice.com[27]Clay NR, Clement DA. The treatment of dorsal wrist ganglia by radical excision. J Hand Surg Br. 1988;13:187-191.http://www.ncbi.nlm.nih.gov/pubmed/3385297?tool=bestpractice.com 当沿着腱鞘囊肿柄移除其周围环绕的正常组织后,其发生率(复发率)会降低。但是,必须小心避免舟月骨的骨间韧带过度切除,否则可能发展成舟月骨分离后果。关节镜清创术后的背侧腱鞘囊肿复发率可能略有升高,介于 7%~11%。[4]Osterman AL, Raphael J. Arthroscopic resection of dorsal ganglion of the wrist. Hand Clin. 1995;11:7-12.http://www.ncbi.nlm.nih.gov/pubmed/7751333?tool=bestpractice.com[26]Kang L, Akelman E, Weiss AP. Arthroscopic versus open dorsal ganglion excision: a prospective, randomized comparison of rates of recurrence and of residual pain. J Hand Surg Am. 2008;33:471-475.http://www.ncbi.nlm.nih.gov/pubmed/18406949?tool=bestpractice.com[29]Luchetti R, Badia A, Alfarano M, et al. Arthroscopic resection of dorsal wrist ganglia and treatment of recurrences. J Hand Surg Br. 2000;25:38-40.http://www.ncbi.nlm.nih.gov/pubmed/10763721?tool=bestpractice.com 开放治疗后的腕掌侧腱鞘囊肿复发率较背侧腱鞘囊肿略有升高,介于 7%~19%。[10]Greendyke SD, Wilson M, Shepler TR. Anterior wrist ganglia from the scaphotrapezial joint. J Hand Surg Am. 1992;17:487-490.http://www.ncbi.nlm.nih.gov/pubmed/1613228?tool=bestpractice.com[28]Wright TW, Cooney WP, Ilstrup DM. Anterior wrist ganglion. J Hand Surg Am. 1994;19:954-958.http://www.ncbi.nlm.nih.gov/pubmed/7876494?tool=bestpractice.com