王江允++陈春丽++杨琳琳++司江勇++杨琼楠++张智风

[摘要]目的：探讨改良二期法耳廓再造术在耳甲腔型小耳畸形中的临床应用效果。方法：2011年1月至2015年9月，本院收治先天性耳甲腔型小耳畸形患者30例，一期手术行耳甲腔型小耳畸形残耳软骨的部分切除，皮下组织蒂皮瓣成形及耳垂的转位；并切取肋软骨行三维立体耳廓软骨支架雕刻成形。二期行颅耳角成形术。结果：本组共30例，一期耳廓成形术后，1例皮瓣部分坏死，经及时修复后治愈，无感染及耳廓软骨支架吸收变形；二期颅耳角成形术后，2例皮片部分坏死，经积极换药后创面愈合。术后随访1年7个月～6年，均取得了良好的手术效果，再造耳廓的形态、大小、位置及角度均与健耳相似，外形逼真，再造耳廓轮廓清晰，竖立稳定。结论：改良二期法耳廓再造术修复耳甲腔型小耳畸形，并发症少，操作简单，周期短，效果好。

[关键词]耳廓再造；小耳畸形；耳甲腔型；肋软骨

[中图分类号]R622 [文献标志码]A [文章编号]1008-6455（2017）09-0006-03

The Application of Modified Two-stage Auricle Reconstructionin

Concha-type Microtia

WANG Jiang-yun，CHEN Chun-li，YANG Lin-lin，SI Jiang-yong，YANG Qiong-nan，ZHANG Zhi-feng

（Department of Otorhinolarnygology Head and Neck Surgery，the Third Peoples Hospital of Zhengzhou，Zhengzhou 450000，Henan，China）

Abstract： Objective To explore the clinical application of modified two-stage auricle reconstruction in concha-type microtia. Methods From January 2011 to September 2015， 30 patients with congenital concha-type microtia were treated in our hospital. The first stage involved the partial of the residual auricle cartilage resection， subcutaneous tissue pedicle flap forming and the earlobe transposition， the costal cartilage was carved into three-dimensional cartilage framework. The second stage was the ear elevation operation. Results There were 30 cases in this group， after one stage of auricle plasty， 1 cases had partial necrosis of the flap and were cured after the repair in time. There was no infection and resorption of the auricle cartilage scaffold. After two cranial ear angle plasty， 2 cases had partial necrosis of the skin， and the wound healed after the change of dressing. All the patients were followed up for 1 years and 7 months to 6 years. Good surgical results were achieved. The shape， size， position and angle of the reconstructed auricle were similar to those of the healthy ear. The shape of the reconstructed auricle was clear， and the stability of the auricle was stable. Conclusion This method has good effect， short cycle， simple operation and few complications.

Key words： auricle reconstruction； microtia； concha-type； cartilago costalis

Nagata[1-4]按殘耳的结构和手术方法的不同将小耳畸形分为耳垂型、小耳甲腔型和耳甲腔型小耳畸形。笔者在临床实践中发现耳垂型和小耳甲腔型小耳畸形的患者发际线较低，乳突区可利用的无毛发皮肤相对较少，更加适合扩张器法耳廓再造术，而耳甲腔型小耳畸形患者的发际线基本正常，且可利用的皮肤和软骨较多，更加适合Nagata法二期耳廓再造术。2011年1月至2015年9月，笔者科室采用二期法耳廓再造术对30例先天性耳甲腔型小耳畸形患者实施自体肋软骨全耳廓再造手术，在原手术方法的基础上进行了改良， 经1年7个月～6年的随访，该手术方法周期短，并发症少，疗效满意，形态逼真。……