先天性耳屏畸形伴外耳道狭窄的分度与手术策略  

Surgical strategy of different congenital tragal malformations with aural stenosis

作　　者：谢友舟 李辰龙 傅窈窈 陈颖 朱雅颖 张天宇 XIE Youzhou;LI Chenlong;FU Yaoyao;CHEN Ying;ZHU Yaying;ZHANG Tianyu(ENT Institute,Department of Facial Plastic and Reconstructive Surgery,Eye&ENT Hospital,Fudan University,NHC Key Laboratory of Hearing Medicine(Fudan University),Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻喉科研究院眼耳鼻整形外科,国家卫生健康委员会听觉医学重点实验室(复旦大学),上海200031

出　　处：《中国眼耳鼻喉科杂志》2022年第4期353-357,共5页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：上海市科学技术委员会“科技创新行动计划”自然科学基金项目(20ZR1409900),上海市科学技术委员会“科技创新行动计划”技术标准项目(21DZ2200700)。

摘　　要：目的针对先天性耳屏畸形伴外耳道狭窄患者,探索不同耳屏畸形程度的联合手术策略。方法本文为回顾性研究。收集2017年12月~2022年4月因先天性耳屏畸形伴外耳道狭窄于我院行手术治疗的患者资料。根据耳屏畸形程度(Ⅰ度附耳畸形、Ⅱ度肥大耳屏畸形、Ⅲ度镜像耳畸形)行耳屏整形手术,利用耳屏冗余皮肤和软骨,联合开展耳内耳甲式外耳道成形术。对耳屏美学、外耳道健康程度及听力结果进行随访并分析。结果共23例患者纳入本研究。耳屏畸形矫正后,利用冗余的皮肤修复外耳道皮肤缺损皮瓣转位3例,全厚皮片移植7例,联合头皮刃厚皮片移植13例。随访6~48个月,所有患者术后耳屏外观良好,外耳道皮肤健康干洁,术后听力明显改善。术后2例出现外耳道口瘢痕性狭窄,给予局部曲安奈德注射后狭窄明显改善。结论利用不同程度耳屏畸形矫正后冗余皮肤和软骨同期开展外耳道成形术,是治疗先天性耳屏畸形伴外耳道狭窄的理想手术策略。Objective To explore the combined surgical strategies for different degrees of congenital tragal malformations with aural stenosis.Methods This was a retrospective study.The data of patients who had undergone surgical treatment for congenital tragal malformations with aural stenosis in our hospital from December 2017 to April 2022 were collected.According to the degree of tragus deformity(Ⅰdegree of accessory tragus,Ⅱdegree of hypertrophic tragus deformity,andⅢdegree of mirror ear deformity),tragus plastic surgery was performed,and the redundant skin and cartilage of the tragus were used as reconstructive materials in canaloplasty.Tragus aesthetics,external auditory canal health and hearing results were evaluated and analyzed during postoperative follow-up.Results A total of 23 patients were included.For the redundant skin after new tragal reconstruction,external auditory canal skin defects were repaired with transposition of pedicled skin flap in 3 cases,full-thickness skin graft in 7 cases and combined methods with blade-thickness skin graft in 13 cases.After 6 to 48 months of follow-up,the postoperative appearance of the tragus was pleased,the skin of the external auditory canal was healthy and dry,and the postoperative hearing was improved.There were 2 cases of meatal restenosis due to scar formation,and the stenosis was significantly improved after local triamcinolone acetonide injection.Conclusions Cartilage and covered skin from the tragus deformity provided the best-available tissues for canaloplasty during the simultaneous tragus reconstruction,and different skin grafting or flap techniques could be used in accordance with the severity of the tragal malformation.Combined surgery is an ideal surgical strategy for the treatment of congenital tragal malformations with aural stenosis.

关 键 词：先天性畸形 外耳 外耳道 外科皮瓣 皮片移植 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]