皮肤软组织扩张法全耳再造术矫治小耳畸形疗效及预后影响因素分析

李妍寸心 朱礼昆 何永静 杨蔚琪 彭程远 张云梅 王继华

[摘要]目的：探讨皮肤软组织扩张法全耳再造术矫治小耳畸形的疗效及预后影响因素分析。方法：回顾性分析2017年8月-2019年11月笔者醫院收治的96例行皮肤软组织扩张法全耳再造术治疗的小耳畸形患者临床资料，观察并发症发生率，并进行6个月随访分析患者预后，根据预后情况分为预后良好组（n=81）和预后不良组（n=15），比较两组临床资料，采用Logistic多因素回归分析影响预后的独立危险因素。结果：本组共96例患者，3例出现术区血肿，1例出现术区感染，2例出现耳支架外露，4例出现血运障碍，并发症发生率为10.42%;对患者进行6个月随访，治疗优良率为84.38%（81/96），总体满意度为88.54%（85/96）。Logistic多因素回归分析显示，年龄、耳廓畸形Max分型、外耳道闭锁分级为影响预后的独立危险因素（P<0.05）。结论：皮肤软组织扩张法全耳再造术治疗小耳畸形效果较好，安全性较高，但年龄、耳廓畸形Max分型及外耳道闭锁分级为影响预后危险因素，临床应给予防御措施。

[关键词]小耳畸形;皮肤软组织扩张术;耳再造术;疗效;危险因素

[中图分类号]R764.7    [文献标志码]A    [文章编号]1008-6455（2021）04-0001-04

Analysis of Curative Effect and Prognostic Factors of Auricle Reconstruction with Skin and Soft Tissue Expansion for Microtia

LI Yan-cunxin，ZHU Li-kun，HE Yong-jing，YANG Wei-qi，PENG Cheng-yuan，ZHANG Yun-mei，WANG Ji-hua

（Department of Plastic Surgery，the Second Affiliated Hospital of Kunming Medical University，Kunming 650031，Yunnan，China）

Abstract： Objective  To analyze the therapeutic effect of auricle reconstruction via skin soft tissue expansion on congenital microtia and factors affecting the prognosis. Methods  Clinical data of 96 patients with congenital microtia who were treated with auricle reconstruction via skin soft tissue expansion in the hospital from August 2017 to November 2019 were retrospectively analyzed. The incidence of complications was observed， and all subjects were followed up for 6 months to analyze the prognosis. The patients were divided into good prognosis group （n=81） and poor prognosis group （n=15） according to the prognosis. Clinical and pathological data of the two groups were compared， and multivariate Logistic regression analysis of independent risk factors affecting the prognosis was performed. Results  There were 96 patients in this group. There were 3 cases with hematoma at surgical site， one case with infection at surgical site， 2 cases with ear framework exposure， and 4 cases with blood circulation disorders. The incidence of complications was 10.42%. During 6 months of follow-up， the excellent and good rate of treatment was 84.38%（81/96）， and the overall satisfaction was 88.54%（85/96）. Multivariate Logistic regression analysis showed that age， Max classification of auricle malformation and aural atresia classification were independent risk factors affecting the prognosis （P<0.05）. Conclusion  Auricle reconstruction via skin soft tissue expansion is effective and safe in the treatment of congenital microtia. Age， Max classification of auricle malformation and aural atresia classification are risk factors affecting the prognosis， which needs clinical intervention.

Key words： microtia; skin and soft tissue expansion; auricle reconstruction; efficacy; risk factors

小耳畸形是多基因遗传的先天性疾病，临床表现为耳部畸形，半面短小等症状，且常伴有同侧外耳道狭窄、闭锁或缺失[1]。据报道显示，我国发病率约为1：3 000，且单侧多于双侧[2]。不仅对患者外貌有很大影响，并给患者带了巨大的心理压力，容易致使抑郁、自卑等不良心理产生，并影响社交[3]。目前常采用皮肤软组织扩张法全耳再造术治疗，可改善外耳畸形，使患者重获信心，提高生活质量[4]。但目前临床对影响疗效的因素相关报道较少，故笔者通过回顾性分析笔者医院收治的96例行皮肤软组织扩张法全耳再造術治疗的小耳畸形患者临床资料，分析其临床疗效和预后影响因素，以期为临床治疗和预防提供可靠的依据，现报道如下。……