三期法功能及耳再造技术在先天性小耳畸形伴耳道狭窄患者中的应用

Three-stage functional ear reconstruction for microtia with congenital aural stenosis

目的探讨三期功能耳再造技术在先天性耳廓畸形伴耳道狭窄患者中的临床应用效果。方法2007年9月至2017年6月，对53例先天性耳廓畸形伴耳道狭窄患者完成三期功能耳再造手术；同期，对445例先天性耳廓畸形患者行常规二期全耳廓再造手术，未行外耳道成形。在三期功能耳再造手术中，一期采用改良的植埋技术，植入耳廓支架，并为二期外耳道成形预留一定的耳甲腔空间；二期在耳甲腔内创新性应用耳内耳甲切口技术，完成外耳道成形以形成新的健康外耳道，根据鼓室内情况开展鼓室成型及听骨链重建；三期采用改良的立耳技术，完成全耳廓再造。若患者表现为外耳道胆脂瘤或感染，可一期行外耳道成形术，若患者已完成全耳廓再造并立耳，可三期行外耳道成形术。结果三期功能耳再造术后53例患者中听力提高到实用水平者41例（77．4％）；外耳道成形后并发症发生率为1．89％；耳廓再造并发症发生率为5．66％。二期全耳廓再造手术的445例患者中，术后并发症发生率为9．43％，与三期功能耳再造中耳廓再造并发症发生率比较，差异无统计学意义（P〉0．05）。结论长期随访结果显示经三期功能耳再造后患者可获得良好的耳廓外形和健康外耳道，多数听力恢复达到实用水平。

Objective To discuss the clinical results of three-stage functional ear reconstruction for microtia with congenital aural stenosis （CAS）. Methods From September 2007 to June 2017, 53 cases of microtia with CAS underwent all three-stage functional ear reconstruction, and 445 cases of microfia underwent two stage ear reconstruction without meatoplasty at the same periods. First-stage of three-stage functional ear reconstruction ： it was similar to Nagata technique. The crus of helix could not be too long, since we needed the space for the next meatoplasty. Second-stage： it was a modified meatoplasty with endoaural-conchal incision, in which two local rotation flaps and a transposition split-thickness scalp flap were used to widen the stenotic external auditory canal （EAC） and reconstructed the tympanic membrane. Third-stage ： it was a modified technique for firm elevation of the reconstructed auricle by using the retro-auricular fascial flap wrapping a porous polyethylene （Medpor） wedge or stored cartilage as the strut. If the patient showed EAC cholesteatoma or infection, we could do the meatoplasty at the first stage. If the patient had completed ear reconstruction, meatoplasty could be done at the third stage. Results 53 cases underwent all three-stage functional ear reconstruction. There were 41 cases （77.4%） obtaining serviceable hearing. The complication rate of meatoplasty was 1. 89% and the complication rate of ear reconstruction was 5. 66%. Among the 445 cases of microtia treated with two stage ear reconstruction without meatoplasty, the complication rate of ear reconstruction was 9. 43%. There was no significant difference between the two groups （ P 〉 0. 05 ）. Conclusions Our novel three-stage functional ear reconstruction is a feasible strategy for microtia with CAS. The patients can obtain satisfactory auricle and serviceable hearing. The results are stable and can improve the life quality in both aesthetics and hearing function.