闭合式切口联合伞形支架行肋软骨综合鼻整形术  

Bilateral endonasal incision combined with umbrella-like graft apply in autologous costal cartilage rhinoplasty

作　　者：曾芳琳 王先成[1] 孙杨[1] 熊祥[1] 孟宪熙 李文波 方柏荣[1] 李晓芳[1] Zeng Fanglin;Wang Xiancheng;Sun Yang;Xiong Xiang;Meng Xianxi;Li Wenbo;Fang Borong;Li Xiaofang(Department of Burn and Plastic Surgery,The Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院烧伤整形外科,长沙410011

出　　处：《中华整形外科杂志》2020年第7期770-775,共6页Chinese Journal of Plastic Surgery

摘　　要：目的探讨采用闭合式切口及伞形支架方式行肋软骨综合鼻整形的方法及效果。方法2018年2月至2019年5月,中南大学湘雅二医院烧伤整形外科为52例患者行自体肋软骨综合鼻整形术,男4例,女48例,平均年龄26.7岁(18~42岁),均采用双侧鼻内切口行伞形支架搭建的手术方法,术中充分分离双侧下外侧软骨,暴露鼻中隔软骨,通过搭建伞形支架以纠正鼻小柱退缩及鼻尖突出度不够等鼻美学缺陷。所有患者术前、后拍照,并在随访期间通过网络或电话完成术后满意度调查。结果52例患者术后即刻显示术前鞍鼻、鼻头肥大、鼻尖不突出、鼻小柱退缩等鼻美学缺陷得以改善,患者住院期间未发生感染、出血等短期并发症。30例患者获6~15个月随访,并同时完成术后满意度调查。术前鼻额角141.29°±5.61°,术后137.67°±5.27°;术前鼻唇角89.53°±10.56°,术后94.90°±5.88°;术前鼻尖角86.60°±7.09°,术后80.42°±5.47°;术前鼻小柱-小叶角48.82°±7.32°,术后44.63°±2.51°;术前鼻尖突出度与鼻长之比0.48±0.07,术后0.54±0.07;术前小叶与鼻小柱长度之比1.74±0.36,术后1.22±0.21。术前、后各项测量指标比较差异具有统计学意义(P<0.05)。术后面诊中患者鼻尖无明显偏曲、下旋、翘曲。术后满意度调查显示,术后3~6周内肿胀基本消失,未发生明显通气障碍、感觉异常及嗅觉减退等功能后遗症,大部分患者对美观及功能结果满意。结论闭合式切口联合伞形支架搭建的手术方式操作简单,闭合式切口允许术中随时进行支架评估调整,术后无鼻小柱切口瘢痕。Objective To introduce a surgical technique applied in autologous costal cartilage rhinoplasty described as the endonasal incision combined with umbrella-like graft.Methods From February 2018 to May 2019,a total of 52 patients(48 females and 4 males)were enrolled and underwent rhinoplasty operation with bilateral intranasal incision for the construction of umbrellal scaffolds in Department of Burn and Plastic Surgery of the Second Xiangya Hospital.During the operation,bilateral inferior lateral cartilages were fully separated and septal cartilages were exposed.Umbrellal-like scaffolds were built to correct nasal aesthetic defects such as nasal columellar shrinkage and insufficient nasal tip protrusion.During the process of follow-up,all the patients were photographed and were asked to complete the the postoperative satisfaction survey by means of an online link or over the phone.Results The preoperative nasal aesthetic defection was greatly improved.There is no the temporary complications including infection and bleeding.30 patients who completed follow-up for 6 months at least and completed postoperative satisfaction survey were included in the case series.The measurements(average):The nasofrontal angle was measured as 141.29°±5.61°preoperation and 137.67°±5.27°postoperation.The nasolabial angle was measured as 89.53°±10.56°preoperation and 94.90°±5.88°postoperation,The nasal tip angle was measured as 86.60°±7.09°preoperation and 80.42°±5.47°postoperation,Columellar-lobular angle was measured as 48.82°±7.32°preoperation and 44.63°±2.51°postoperation,The tip projection-nasal length index was measured as 0.48±0.07 preoperation and 0.54±0.07 postoperation.Columellar-lobular length index was measured as 1.74±0.36 preoperation and 1.22±0.21 postoperation,There were significantly statistical differences between preoperative and postoperative measures.The photograph showed the location and reflection of nasal tip have remained stable,no upward or twist trend occurred.According to questionair

关 键 词：闭合式切口 伞形支架 自体肋软骨 鼻综合整形术 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]