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目的总结探讨耳廓良性肿物的手术切除方法和肿物切除后组织缺损的修复方式与技巧。方法对我科2013.1-2017.12间收治的92例耳廓良性肿物的临床资料进行回顾性分析,所有病例均行普通外科手术方法完整切除,切除后组织缺损需修复者30例,其中11例行游离皮片移植,19例行耳前/后带蒂皮瓣或移行皮瓣移植。全部病例均随访半年以上。结果 92例耳廓良性肿物切除后直接缝合62例,均获一期愈合。切除后组织缺损修复30例,其中耳后游离皮片移植11例中9例一期愈合,2例术后3天出现皮片色泽暗紫、皮片下渗出积液改变,经及时换药等处理后愈合;皮瓣修复19例中,17例一期愈合,2例耳后带蒂皮瓣病例术后3天左右出现皮瓣色泽暗紫、其中1例皮瓣下有血脓性分泌物,经清除分泌物等处理后,皮瓣存活且无明显瘢痕挛缩表现。随访期内,术后复发2例均为瘢痕疙瘩术后未同期行局部放疗者。结论耳廓良性肿物切除后预后较好,同期缺损常根据缺损的大小、部位、肿物性质、皮肤条件等因素设计合适的修复方法,以最大限度恢复外形。耳后游离皮片和耳后带蒂皮瓣在组织缺损修复中应用较多。手术切除并同步局部放疗是耳廓瘢痕疙瘩的良好选择。
Abstract：Objective To report surgical excision of auricular benign tumors and repair of subsequent defect.Methods The study reviewed 92 cases of auricular benign tumors treated from 2013 to 2017 in our hospital. All tumors were surgically resected. Defects repair was needed in 30 cases, of which 11 were treated with skin graft and 19 with pre-/post-auricular pedicle flap or random pattern skin flap. The patients were followed up for at least 6 months. Results Direct wound closure resulted in good healing in 62 cases. In the 11 cases where post-auricular skin grafts were used for repair, grafts became dark colored with little exudation on postoperative day 3 in 2 cases which resolved after local treatment, while healing in the other 9 cases was uneventful. In the 19 cases repaired with pedicle flaps, primary healing was achieved in 17 cases, while in 2 cases there were dark discoloration, exudation(purulent in 1 case) and escharosis that required drainage and debridement, resulting in flaps survival and healing with minimal scar or contracture. The two recurrences during the follow-up were both related to no local radiotherapy after keloid excision. Conclusion The prognosis of surgical resection of auricular benign tumors is good. Depending on the size and location of tissue defect, tumor characteristics and skin condition, repair can be designed for best cosmetic outcomes, for which post-auricular skin grafts and post-auricular pedicle flaps are most commonly used. Surgical resection plus concurrent local radiation is a good choice in managing keloid.
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基本信息:
中图分类号:R764.9
引用信息:
[1]姚琳莉,喻璐,张碧波,等.耳廓良性肿物切除及缺损修复92例临床分析[J].中华耳科学杂志,2018,16(05):676-680.
基金信息:
湖北省卫计委科研课题面上项目资助(WJ2017M179)~~
2018-10-15
2018-10-15