100天内大龄儿先天性耳廓畸形无创矫正长期疗效观察  

Long-term Observation of Ear Molding in Older Infants within 100 Days with Congenital Auricular Deformities

作　　者：钟贞[1] 刘玉和[1] 张俊波[1] 张燕梅[1] 任蕾 秦瑶[1] 肖水芳[1] ZHONG Zhen;LIU Yuhe;ZHANG Junbo;ZHANG Yanmei;REN Lei;QIN Yao;XIAO Shuifang(Department of Otolaryngology,Head and Neck Surgery,Peking University First Hospital,Beijing 100034 China)

机构地区：[1]北京大学第一医院耳鼻咽喉头颈外科,北京100034

出　　处：《中华耳科学杂志》2020年第3期469-474,共6页Chinese Journal of Otology

基　　金：北京市科学技术委员会资助项目(Z191100006619027)。

摘　　要：目的分析耳廓无创矫正在较大天龄儿(即大龄儿,≥3周)先天性耳廓畸形(congenital auricular deformity,CAD)治疗中的疗效,探讨其在此类患儿中实施的意义。方法回顾性分析2018年1月-2019年2月于我科诊治的28例CAD大龄儿临床资料。所有患儿均于就诊当日接受EarWell耳廓矫治器治疗,每周返院复查一次,至矫正满意或连续3周复查耳廓形态无明显改变定义为矫正结束。评估其矫正后的即时疗效和长期随访疗效。结果所有28例患儿中3例因严重湿疹中途退出治疗(10.7%),因此,最终完成矫正的CAD大龄儿共25例(89.3%),中位天龄44天(范围23-100天),男性及女性大龄儿分别为16及9例。所有患儿中,双耳及单耳受累者分别为11例及14例,因此共36耳纳入最终分析,包括:招风耳3例、垂耳6例、隐耳2例、Stahl’s耳4例、耳轮脚畸形2例、以及卷曲耳19例(1度、2度及3度分别为3例、13例及3例)。所有患耳中位矫正时间4周(范围2-7周),矫正结束时仅1例2度卷曲耳形态无明显改善被评估为无效,因此即时有效率达97.2%(35/36);36耳矫正过程中发生压疮11例(30.6%),湿疹4例(11.1%),均可在暂停治疗1周内缓解。长期随访进行评估(≥180天),部分病例形态出现一定程度反弹,有3例2度卷曲耳及2例招风耳因形态明显反弹最终被评定为无效,因此,最终有效率为83.3%(30/36),除招风耳及2度卷曲耳疗效偏低外(分别为33.3%及69.2%),其余类型疗效仍可达100%。结论本组观察的100天内的大龄儿,2度以上卷曲耳及招风耳无创矫正后长期耳廓形态可能发生明显反弹,尤其是招风耳,对此类患儿实施此治疗应慎重。尽管如此,在其他类型CAD的治疗中,无创矫正仍具有良好的疗效。Objective To analyze the immediate and long-term efficacy of the ear-molding technique in treating congenital auricular deformity(CAD)in infants older than the ideal age(≥3 weeks).Methods The clinical data of 28 older CAD infants(≥3 weeks)who were treated in our institution from Jan 2018 to Feb 2019 were retrospectively studied.All these patients were treated with“EarWell”system and were followed up every week during molding.The treatments stopped until a normalization of the ear anatomy was achieved,or when there were no significant changes for three continuously weeks.The long-term follow-up were all done over 6 months after the end of treatment.The immediate and long-term efficacy were both evaluated.Results Three patients withdrew the treatment because of severe dermatitis,and,therefore,25 patients completed the treatments and were finally included.There were 16 boys and 9 girls,with a median age of 44 days(range:23-100 days).The bilateral deformities presented in 11 of the 25 patients,and,therefore,a total of 36 ears with CAD were studied,including prominent ear for 3(8.3%),lidding ear for 6(16.7%),cryptotia for 2(5.6%),Stahl’s ear for 4(11.1%),conchal crus for 2(5.6%),and constricted ear for 19(52.8%)(the numbers of class I,class II,and class III were 3,13,and 3,respectively).The median treatment time was 4 weeks(range:2-7 weeks).The immediate success rate was as high as 97.2%(35/36),with only one class II constricted ear considered to be failure.The complications included minor pressure ulcerations(11 ears,30.6%)and eczema(4 ears,11.1%)which relieved within one week after treatments.The long-term follow-up showed obvious relapses in three class II constricted ears and 2 prominent ears,and the final success rate was 83.3%(30/36).The final success rates in prominent ears and class II constricted ears were only 33.3%and 69.2%,respectively.While in other types of CAD,the final success rates was 100%.Conclusion For older CAD infants,the relapses tended to happen in prominent ear and moderate to severe

关 键 词：先天性耳廓畸形 婴幼儿 耳廓矫正 

分 类 号：R764[医药卫生—耳鼻咽喉科]