“Millard+”法修复单侧唇裂术后继发唇鼻部畸形效果观察.docVIP

“Millard+”法修复单侧唇裂术后继发唇鼻部畸形效果观察 　　[摘要]目的：寻求更高效的修复单侧唇裂术后继发的多项唇鼻部畸形的方法。方法：局部麻醉下，采用以Millard法（Ⅰ式或Ⅱ式）为基础，联合其他各种方法（以下简称“Millard+”法）一次性修复单侧唇裂术后继发的唇鼻部多项畸形。结果：对本组22例单侧唇裂术后继发唇鼻部多项畸形的患者（排除上唇过紧情况），均采用“Millard+”法进行手术修复，经一次手术获得修复多项畸形的结果。其中16例于术后3～12个月获得随访，根据患者自我评价，满意16例（100%）。结论：采用“Millard+”法，可以经过一次手术较好地修复单侧唇裂术后继发唇鼻部多项畸形，特别是在增加上唇长度、抬高患侧鼻底、收窄患侧鼻孔、矫正鼻小柱偏斜等方面效果显著。该方法不仅可以较大程度矫正畸形，而且可最大限度减少对下次手术的影响。 　　[关键词]唇裂；继发畸形；上唇畸形；鼻畸形；Millard法；修复 　　[中图分类号]R765.9 R782.2 [文献标志码]A [文章编号]1008-6455（2015）22-0017-04 　　Abstract： Objective To explore an effective method to repair the upper lip and nasal deformities secondary to unilateral cleft lip. Methods According to the situation of deformities， the Millard（typeⅠor typeⅡ）combine with other various surgical methods（“Millard+”for short）were used to repair multinomail deformities of upper lip and nose secondary to unilateral cleft lip one time.The operative result was divided into three degree：good，acceptable and bad，and was evaluated by patients themselves. Results 22 cases who had multinomial deformities on upper lip and nasal secondary to repair of cleft lip were operated with the method of Millard+.16 of 22cases were followed up from 3 months to 12 months of post-operation，16 of them obtained satisfactory results（good+acceptable）， the rate of satisfactory is 100%. Conclusion Multinomial deformities on upper lip and nasal secondary to repair of unilateral cleft lip（except the situation of tension on upper lip）can be repaired better with“ Millard +”method at the same time.It is effective， simple and safe. 　　Key words：cleft lip；secondary deformity；deformity of upper lip；deformity of nose；Millard method；repair 　　唇裂修复术后往往在唇部和鼻部还同时存在多项的、各种各样的、程度不一的畸形，再次手术修复的难度较大，不仅因为畸形表现各异，而且相互影响[1]。同时医师的治疗思路和经验对治疗结果影响也很大。目前，对于该类畸形的手术处理大多局限于某一、二项畸形，而且对剩余畸形的影响考虑较少，缺乏系统性，不仅不能减少手术次数，而且极有可能对剩余畸形的修复带来不便[2]。为能够通过一次手术获得多项畸形矫正，笔者自2007年始，应用以Millard法为基础联合其他多种手术方法（以下简称“Millard+”法）对22例成年人单侧唇裂术后继发鼻唇部多项畸形的患者进行手术矫正，获得满意疗效[3-5]。报道如下。 　　1 资料和方法 　　1.1 一般资料 　　本组22例，男20例，女2例。年龄19～