自体肋软骨鼻成形术并发症的预防及处理

Prevention and treatment of the complications of autograft rib rhinoplasty

目的探讨中国人自体肋软骨鼻成形术并发症的防治。方法收集2010年1月至2017年8月,中南大学湘雅二医院烧伤整形外科209例行自体肋软骨鼻成形术患者资料进行分析,其中14例患者出现并发症(6.7%)。结果195例患者表示术后效果满意,未出现并发症。术后出现并发症者14例。其中软骨变形12例,占5.7%,其中4例认为变形在可接受范围内,未行修复手术;8例再次雕刻修复术后无明显软骨弯曲。软骨明显吸收3例,其中2例合并软骨变形,1例合并感染,占1.4%,均未接受修复手术。感染合并软骨吸收1例,占0.5%,经保守治疗感染控制好转,软骨未取出。胸部瘢痕增生1例,占0.5%。结论通过选择肋软骨平直部分,保留髓质,对称雕刻法与交叉横切法等措施可明显减少软骨变形。术中严格无菌及精细操作可减少感染、气胸及瘢痕增生等并发症。

Objective To discuss the prevention and treatment of the complications of rib rhinoplasty in Chinese.Methods A total of 209 patients received rib rhinoplasty in which postoperative complications happened in 14 cases from Jan.2010 to Aug.2017,and the clinical data were analyzed retrospectively.Results 195 patients showed satisfactory results and no complications.Postoperative complications occurred in 14 cases.There were 12 cases of rib cartilage warping (incidence rate was 5.7%).4 cases were thought that warping was within acceptable range,and 8 cases had satisfactory results after the secondary repair surgery.There were 3 cases of resorption of rib cartilage (incidence rate was 1.4%),of which 2 cases were complicated with cartilage warping and 1 case complicated with infection.None of them underwent repair surgery.The infection complicated with cartilage resorption was 1 case (0.5%).The infection was improved by conservative treatment and the cartilage was not removed.There was 1 case of hypertropic scar on chest wall (incidence rate was 0.5%).Conclusions The warping of cartilage can be significantly reduced by selecting straight section of costal cartilage, preserving the central costal cartilage grafts,symmetrically carving and crosscutting.Meanwhile,sterility and accurate operation can decrease the incidence of infection,aerothorax and scars.