不同整形技术治疗儿童唇裂鼻畸形的临床效果

Clinical outcomes of different plastic surgeries for children with cleft lip nasal deformity

目的探讨不同整形技术治疗儿童唇裂鼻畸形的临床效果。方法本院自1994年1月至2011年1月期间对本院133例单侧唇裂继发鼻畸形患者分为自行设计的鼻翼软骨环状结构修复及整体旋转复位治疗组（A组）36例、开放式唇裂鼻畸形整形术治疗组（B组）47例、新生儿唇裂修复组（C组）28例以及早期唇裂鼻畸形整形术组（D组）22例，对比分析不同手术方法的临床疗效。结果术后对4组患者随访24个月，A组优良率为94．44％，B组优良率为97．87％，C组优良率为96．43％、D组优良率为95．45％，各组优良率比较差异无统计学意义（P〉0．05）。4组治疗前鼻翼外侧脚及鼻孔纵径至中线距离术前健侧及患侧相比均存在明显的差异（P〈0．05），矫正后各组健侧与患侧相比差异无统计学意义（P〉0．05）。随访2年各组患者术后并发症发生率差异无统计学意义（P〉0．05）。结论鼻翼软骨环状复合结构修复使鼻尖、鼻翼及鼻底形态都有所改善，开放式唇裂继发鼻畸形整形术是目前较彻底的鼻翼软骨整形术，新生儿唇裂修复安全有效。唇裂修复早期的鼻整形有望改善鼻形态发育。

Objective To explore clinical outcomes of different plastic surgeries for children with cleft lip nasal deformity. Methods A taral of 133 patients of unilateral cleft lip with secondary nasal deformity registered to our hospital between January 1994 and January 2011 were recruited in this study. These patients were allocated to receive self-designed repair and overall rotation reduction of the alar cartilage ring （group A, n=36）, open plastic surgery for cleft lip nasal deformity （group B, n=47）, neonatal cleft lip repair （group C, n=28）, or early cleft lip rhinoplasty （group D, n=22）. The clinical efficacy of different plastic surgeries were compared and analyzed. Results The patients were followed up for 24 months after surgery. Excellent outcomes were achieved in 94.44%, 97.87%, 96.43%, and 95.45% of the patients in groups A, B, C, D, respectively. There was no significant difference in the rate of excellent outcomes between groups （P〉 0.05）. In all 4 groups, there was obvious difference in the distances from midline to the lateral crus of alar cartilage and to the longitudinal axis of nostril between cleft and healthy sides before operation （P〈 0.05）, which was not found after plastic surgeries （P〉0.05）. There was no significant difference in postoperative complications among the 4 groups during the 2-year follow-up （P〉0.05）. Conclusion Repair of alar cartilage ring complex may improve the appearance of nasal tip, nasal alar and nasal floor. Open plastic surgery for cleft lip with secondary nasal deformity is by far the most thorough alar cartilage plastic surgery. Neonatal cleft lip repair is safe and effective. Early repair of cleft lip rhinoplasty is promising for better nasal morphogenesis.