上唇改良梯形黏膜肌皮瓣修复双侧唇裂的临床研究

A Clinical Study on Vermilion Reconstruction of Bilateral Cleft Lip Using A New Trapezoidai Flap

【目的】探讨双侧上唇改良梯形黏膜肌皮瓣术式修复双侧唇裂的临床效果。【方法】选择2008年1月至2014年1月本院收治的双侧唇裂患儿96例，根据手术方法不同分为两组：观察组52例，采用双侧上唇改良梯形黏膜肌皮瓣术式}对照组44例，采用直线缝合法。比较两组修复后的临床效果。【结果】术后随访1～5年，90例患儿伤口均为一期愈合，5例裂隙宽大的患儿因就诊较晚无法前期矫正，术后伤口张力较大且有不同程度感染，1例实施双侧上唇改良梯形黏膜肌皮辩术式后患儿鼻底处出现复裂。3例实施双侧上唇改良梯形黏膜肌皮瓣修复的双侧混合性唇裂患儿术后出现双侧不对称畸形。观察组患儿术后1～2年出现口哨畸形、丘比特弓不连续的发生率明显低于对照组（P〈0．05），而两组患儿术后1～2年出现上唇过紧或过长的发生率比较差异无统计学意义（P〉0．05）。【结论】双侧上唇改良梯形黏膜肌皮瓣修复双侧唇裂效果良好，术后畸形发生率低于直线缝合法，值得临床推广应用。

[Objective]To evaluate the efficacy of vermilion reconstruction of the bilateral cleft lip using a new trapezoidal flap.[Methods]This study was conducted on 96 patients with bilateral cleft lip who came to our hospital from January 2008 to January 2014. These patients were randomly divided into group 1 and group 2; the 52 cases in group 1 underwent the modified trapezoidal flap for vermilion reconstruction while the 44 cases in group 2 were treated with the straight line closure. The shape of vermilion, whistle deformities, and Cupid＇s bow deformities were observed postoperatively with follow-up appointments at 7 days and 1-2 years. [Results]At the time of the follow-up 1 to 2 years postoperative, 90 cases of children＇s wounds were healed, 5 cases that started with a large gap and had late treatment failed to be corrected and had postoperative high wound tension and resulting wound infection, 1 case showed nasal rupture after surgery with bilateral upper lip trapezoidal mucosal myocutaneous flap. Three cases of bilateral mixed cleft lip who undergone bilateral upper lip trapezoidal flap surgery had some asymmetrical deformities after operation. Within 1 - 2 years, the incidence of whistle deformity and Cupids bow deformities in the observation group was significantly lower than that in the control group （ P 〈0.05）, but there was no significant difference between the two groups in terms of upper lip tension or length（ P 〉 0.05） .[Conclusion]Vermilion reconstruction of bilateral cleft lips using the new trapezoidal flap surgery is a useful method with a high success rate, especially for the reconstruction of the vermilion, labial arch, and vermilion tubercle. Its incidence of postoperative deformities is lower than the straight suture method and is worthy of clinical application.