耳甲腔型小耳畸形的临床治疗进展

Research progress of clinical therapy for concha-type microtia

目的总结耳甲腔型小耳畸形的临床治疗进展。方法查阅近年国内外有关耳甲腔型小耳畸形治疗的相关文献,就手术时机、术式选择以及并发症等方面进行总结分析。结果耳甲腔型小耳畸形病因不明、治疗方法多样,目前缺乏统一诊疗规范。临床常用术式主要为自体肋软骨移植部分耳再造术和对侧耳廓复合组织移植术两种。前者手术时机选择主要参考患儿肋软骨发育情况及其心理两方面;后者手术时机选择主要依据畸形严重程度,对于轻度患者建议10岁左右直接行对侧耳廓复合组织移植术矫正,中度建议1~2岁时行耳软骨舒展术、10岁左右行对侧耳廓复合组织移植术矫正。自体肋软骨移植部分耳再造术并发症主要包括支架外露、支架变形、感染、软骨吸收、皮肤坏死等;目前尚未见对侧耳廓复合组织移植术并发症的报道。结论耳甲腔型小耳畸形的发病原因、精细分型分度标准及相应的个性化治疗将是主要研究方向。

Objective To summarize the current progress of clinical therapy for concha-type microtia.Methods The domestic and overseas literature about the treatment of concha-type microtia was reviewed and the contents of operative timing,operation selection,and complications were analyzed.Results The unified therapeutic schedule of the concha-type microtia has not yet been determined due to its complicated various therapeutic methods and unknown etiology.The operation methods commonly used in clinic are partial ear reconstruction with autologous costal cartilage framework and free composite tissue transplantation.The timing of the partial ear reconstruction depends on the development of costal cartilage and children’s psychological healthy.The timing of free composite tissue transplantation depends on the severity.It is recommended to perform the operation at about 10 years old for mild patients.For moderate patients,ear cartilage stretching should be performed at 1-2 years old and free composite tissue transplantation would be performed at about 10 years old.The complications of partial ear reconstruction with autologous costal cartilage framework for concha-type microtia mainly include framework exposure,deformation,infection,cartilage absorption,and skin necrosis.The complications of free composite tissue transplantation have not been reported.Conclusion Etiology and elaborated classifications with individualized treatment are the future research directions.