单侧唇裂个体化修复设计应用.docVIP

单侧唇裂个体化修复设计应用[摘要]目的：探讨单侧唇裂的临床分型，根据分型制定个体化修复术式，评价手术效果。方法：50例单侧上唇裂患者，平均年龄4.8个月，包括单侧完全性唇裂、单侧不完全性唇裂，根据唇高分为4型，分别对各型应用个体化设计手术方法、制定术后效果评定方法，观察术后近期效果。结果：所有患者手术后近期唇弓、唇红、唇珠恢复好，鼻畸形得到改善。结论：单侧唇裂修复根据临床分型应用个体化唇裂修复设计，手术疗效满意。 [关键词]单侧唇裂；临床分型；唇裂修复术 [中图分类号]R782 [文献标识码]A [文章编号]1008-6455（2011）10-1552-03 Individual design of surgical repair for unilateral cleft lip DONG Xi-yin1,WEI Ming-yong1,TANG You-sheng2 (1.Department of Oral and Maxillofacial Surgery,Affillated Hospital of Jining Medical College,Jining 272129, Shandong,China;2.Department of Oral and Maxillofacial Surgery,Ninth People’s Hospital，College of Stomatollogy,Shanghai Jiaotong University) Abstract:ObjectiveTo evaluate the effect of individual design of surgical repair for unilateral cleft lip.MethodsFifty patients (mean age of 4.8 months) with unilateral cleft lip were divided into 4 types according to the lip height,individual design of surgical repair was applied based on the type of unilateral cleft lip.The postoperative effect was observed and compared among the 4 groups.ResultsAll patients had a good postoperative upper lip shape.Lip bow,vermilion,lip beads,lip kiss-line recovery were satisfactory at the same time proper correction of nasal deformities.ConclusionThe individual design of surgical repair is feasible for various type for unilatreal cleft lip. Key words:unilateral cleft lip;clinical classification;cheiloplasty 单侧唇裂的修复方法很多，目前应用最为广泛的是Millard法及改进术式、部分使用Tennision法、长庚纪念医院之颅颜面中心罗慧夫法、华西梯度旋转下降术式[1]、上海九院王国民教授唇裂修复的新方法[2]等，总的来所说前3型术式效果不理想，后两种术式临床应用逐年增多，术后效果良好，但仍有部分病例术后唇高不足、鼻外形差；究其原因，笔者认为，单一固定术式来修复变化不定的上唇裂畸形、产生的的效果显而易见就难以恒定。有必要根据上唇唇高对单侧上唇裂进行更为细化的分型来制定手术术式。本组50例单侧上唇裂患者进行分型后手术效果满意。 1材料和方法 1.1 病例资料：本组共50例单侧唇裂患者，完全性唇裂32例，不完全性唇裂18例，12例患者伴有牙槽嵴裂，年龄3～11个月，平均4.8月，根据唇高分类法，将裂隙内外侧唇高与健侧唇高比较，唇高相差2cm以内为唇高接近正常，裂隙内外侧唇高小于健侧唇高3mm为唇高不足。A型：唇裂裂隙内外侧唇高接近正常型；B型裂隙内侧唇高接近正常、裂隙外侧唇高不足型；C型裂隙内侧唇高不足，裂隙外侧唇高接近正常型；D型裂隙内侧、外侧唇高不足型。其中A型5例，B型2例，C型20例，D型23例；从统计上看C、D型病例较多。A型整复原则为内外稍微互补或不互补，手术选择术式为完全性单侧唇裂用Millard法、不完全单侧唇裂用上三角瓣小瓣修复或