内镜辅助切取颞浅筋膜瓣在Nagata法二期耳廓再造中的应用  

Effects of endoscope assisted temporoparietal fascia flap harvest for the second-stage operation in auricular reconstruction of Nagata’s technique

作　　者：王振宇 王洪一 金元 张庭辉 徐志山 梁久龙 Wang Zhenyu;Wang Hongyi;Jin Yuan;Zhang Tinghui;Xu Zhishan;Liang Jiulong(Department of Burns and Plastic Surgery,General Hospital of Northern Theater Command,Shenyang 110000,China)

机构地区：[1]北部战区总医院烧伤整形科,沈阳110000

出　　处：《中华整形外科杂志》2023年第11期1222-1228,共7页Chinese Journal of Plastic Surgery

基　　金：辽宁省科学技术基金(2023010052-JH2/1013)。

摘　　要：目的观察在小耳畸形Nagata法二期耳廓再造中应用内镜辅助切取颞浅筋膜瓣的作用。方法回顾分析2015年1月至2022年1月,北部战区总医院烧伤整形科收治的小耳畸形患者临床资料。根据颞浅筋膜瓣切取方法,将患者分为2组:内镜组和开放手术组。在小耳畸形Nagata法二期耳廓再造中,内镜组应用内镜切取颞浅筋膜瓣,开放手术组应用传统开放手术方式切取颞浅筋膜瓣。术后定期随访观察颞浅筋膜瓣成活、并发症发生情况。采用耳廓再造患者满意度问卷调查患者满意度,患者与观察者瘢痕评估量表(POSAS)评估术区瘢痕。采用SPSS 26.0统计学软件进行数据分析,2组患者年龄、住院时间、术中出血量、瘢痕长度、患者满意度、POSAS得分比较采用t检验,2组患者性别构成比、并发症发生率比较采用卡方检验,P<0.05为差异有统计学意义。结果共纳入51例患者,其中内镜组26例,男14例,女12例,年龄(9.8±2.9)岁(7~17岁);开放手术组25例,男12例,女13例,年龄(10.3±3.8)岁(7~17岁)。术后随访(15.4±3.4)个月(1~2年),所有筋膜瓣均成活,无严重并发症发生。2组患者年龄、住院时间、术中出血量、患者满意度、性别构成比、术后并发症分别比较,差异均无统计学意义(P均>0.05)。内镜组术区瘢痕长度比开放手术组短[(8.2±1.4)cm vs.(15.8±1.9)cm],POSAS评分低于开放手术组,差异均具有统计学意义(P<0.05)。结论小耳畸形Nagata法二期再造术应用内镜辅助切取颞浅筋膜瓣可以减少术后瘢痕生成,改善术后外观,对耳廓再造外形、并发症发生率无影响。ObjectiveTo observe the efficacy the application of endoscope assisted temporoparietal fascia flap harvest for the second-stage operation in auricular reconstruction of Nagata’s technique for microtia.MethodIn this retrospective study,the clinical data were collected from the patients who received microtia reconstruction with autologous rib cartilage at the Department of Burns and Plastic Surgery,General Hospital of Northern Theater Command from January 2015 to January 2022.According to the surgical procedure,patients were divided into endoscopic group and open surgery group.In endoscopic group,endoscope-assisted temporoparietal fascia harvest were performed for the second-stage operation in auricular reconstruction of Nagata’s technique.In open surgery group,temporoparietal fascia flaps were harvested in open surgery for the second-stage operation in auricular reconstruction of Nagata’s technique.Regular follow-up was conducted to observe the survival of the fascia flaps,complications,patient satisfaction,and surgical scars.The patient satisfaction questionnaire for auricular reconstruction was used to assess patient satisfaction,and the patient and observer scar assessment scale(POSAS)was used to evaluate scar formation in the surgical area.Data analysis was performed using SPSS 26.0 statistical software.The measurement data were expressed by Mean±SD,and the counting data were expressed as cases(%).The T-test was used to compare the age difference,length of hospital stay,intraoperative blood loss,scar length,patient satisfaction,and POSAS scores between the two groups.Chi-square test was used to compare the gender composition and incidence of complications between the two groups.P<0.05 was considered statistically significant.ResultsA total of 51 patients were included,with 26 in the endoscopic group(14 men and 12 women)and 25 in the open surgery group(12 men and 13 women).The age of the patients in the endoscopic group was(9.8±2.9)years(ranging from 7 to 17 years),while in the open surgery group was(10

关 键 词：瘢痕 先天性小耳 外耳 病人满意度 耳廓再造术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]