先天性耳垂裂的外科治疗：6例报告及相关文献复习  

Surgical repair of congenital coloboma： 6 cases report and literature review

作　　者：张晨[1] 葛春颖[1] 孙琳[1] 

机构地区：[1]大连大学附属新华医院,整形外科,辽宁大连116021

出　　处：《中国美容整形外科杂志》2011年第12期723-727,共5页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的 总结耳垂裂的外科修复方法.方法 对过去5年治疗的6例患者的治疗经验进行总结.并对过去20年有关耳垂裂外科治疗的中英文文献进行复习.总结耳垂裂外科修复的手术方法及术式选择.本组6例7侧耳垂裂,其中Kitayama分类Ⅰ型者2例（3侧）,Ⅱ型者1例,Ⅲ型者1例,Ⅳ型者2例.6例患者分别采用双舌形皮瓣法、皮下蒂组织移植法、改良的Bhandari及皮瓣复合软骨移植法治疗.结果 6例患者均取得满意效果.其中1例术中发现转移的耳垂前叶颜色略紫,采用针头针刺耳垂下极和按摩后,于术后48h移植的耳垂前叶颜色正常.结论 结合临床经验和文献复习,我们认为,对于Ⅰ型耳垂裂,可选用前后两面相反的Z成形术、三角瓣法、L成形术;对于完全性Ⅰ型耳垂裂,可选用两皮瓣法或Bhandari的方法.对于Ⅱ型耳垂裂,以皮下蒂转移将次要耳垂瓣转移至主要耳垂瓣内下方修补内下缺如,可获得满意形态.对于裂隙较浅的患者,潜行分离并释放出前后叶间的皮肤,将前后叶贴合再造新耳垂.对于Ⅲ型耳垂裂,治疗上可借鉴Bhandari的方法,也可以优势的两叶间皮肤为蒂,将非优势叶转移至优势叶下方,修复期间的缺损.对于Ⅳ型耳垂裂,采用双蒂瓣法、改良的Bhandari方法及耳后皮瓣复合耳甲腔软骨移植,均可获得满意的形态.Objective To summarize the repair methods for the reconstruction of congenital coloboma lobuli. Methods A retrospective study was carried out on the clinical data of 6 patients received in last 5 years, and a literature review was performed on both Chinese and English papers about the surgical treatment of congenital coloboma lobule presented in last 20 years, simultaneously. The surgical methods were summarized and illustrated. Totally 6 cases with 7 ears were studied in this group, including Kitayama＇ classification type Ⅰ 2 cases （3 ears）, type Ⅱ 1 case, type Ⅲ1 case and typeⅣ 2 case, and they were treated by double tongue-shaped flap, pedicel flap, modified Bhandari＇ method, and composite graft of flap and cartilage, respectively. Results Six patients were satisfied with the results except one case with transferred anterior lobe of auricular lobule slight purple during operation, which was recovered by puncturing radix nasi of auricular lobule by needle and massage at 48 hours postoperatively. Conclusion Based on our experiences and analysis to literature review, incomplete type Ⅰcoloboma lobuli can be repaired by Z-plasty, triangular flap and L-plasty, complete type [ coloboma lobuli can be repaired by double-flap or Bhandari＇s method; For type Ⅱ coloboma lobuli, the deformity can be repaired by transferring the minor part of the cleft lobes to close the defect or by releasing the skin between the two cleft lobes; For type Ⅲcoloboma lobuli, it can be repaired by Bhandari＇s method or transferring the minor part of the cleft lobes to close the defect between the two major lobes ; type Ⅳis congenital absent of earlobe, so it can be reconstructed by modified Bhandari＇s method or two flaps designed on the stub-end of the deformed ear and the tissue below the deformed ear.

关 键 词：耳垂裂 外科手术 分类 

分 类 号：R622[医药卫生—整形外科]