目的探讨采用自体肋软骨雕刻行唇裂术后继发鼻畸形个体化治疗的手术方法及疗效。方法 2009年9月-2014年1月收治唇裂术后继发鼻畸形患者350例,其中男160例,女190例;年龄16~56岁,平均18.2岁。单侧唇裂术后鼻畸形200例,双侧150例。唇裂手术至鼻畸形矫形手术时间间隔2~50年,平均12年。术中取患者同侧或对侧第6或第7肋软骨2~6 cm,将肋软骨拼接并雕刻成“个”字形结构,其中上半部的“人”作为两侧鼻翼软骨的加强,下半部的“1”作为鼻小柱及鼻中隔软骨的加强,剩余肋软骨切碎成0.1 mm×0.1 mm×0.1 mm大小颗粒。采用鼻小柱阶梯状切口,将拼接并雕刻成“个”字形的肋软骨移植于鼻翼塌陷侧,同时将剪成颗粒状的肋软骨注射填充入鼻背部,达到隆鼻效果。术后1、6、12个月,参照张莉等的唇裂继发鼻畸形修复疗效评价标准评价手术疗效。结果术后患者切口均Ⅰ期愈合。350例均获随访,随访时间1~12个月,平均6个月。术后患者患侧塌陷鼻翼得到提升,与健侧鼻翼高度基本一致,鼻孔形态基本对称,同时鼻小柱歪斜纠正,鼻梁塌陷得到很大改善,鼻部形态基本协调,效果美观。术后1、6、12个月患者疗效评价优良率分别为98.6%、97.4%、97.1%,比较差异均无统计学意义(χ2=0.545,P=0.761)。结论采用自体肋软骨雕刻行唇裂术后继发鼻畸形个体化治疗,能够取得良好的手术效果。 Objective To investigate the surgical method and curative effect of individualized nasal deformity treatment after self-costal cartilage sculpting. Methods From September 2009 to January 2014, 350 patients with secondary nasal deformities after cleft lip surgery were enrolled, including 160 males and 190 females, aged from 16 to 56 years (average 18.2 years). Unilateral cleft lip nasal deformity in 200 cases, bilateral 150 cases. Cleft lip surgery to nasal deformity surgery time interval of 2 to 50 years, an average of 12 years. Intraoperative patients with ipsilateral or contralateral 6 or 7 costal cartilage 2 ~ 6 cm, costal cartilage stitching and carved into a “” shape structure, in which the upper half of the “people” as both sides of the nose Cartilage strengthening, the lower half “1 ” as the columella and nasal septum cartilage strengthening, the remaining costal cartilage chopped into 0.1 mm × 0.1 mm × 0.1 mm size particles. The nasal cartilage ladder-like incision was used to transfer the costal cartilage spliced ​​and engraved into the shape of ribbed cartilage on the collapse side of the alar nose, and the rib cartilage cut into granular shape was injected into the back of the nose to achieve rhinoplasty effect. At 1, 6, and 12 months after operation, the curative effect was evaluated according to the standard of evaluation of curative effect of nasal deformity secondary to cleft lip. Results Postoperative incision healed in all cases. 350 cases were followed up for 1 to 12 months with an average of 6 months. The contralateral nasal alar wing was improved in patients with postoperative collapse, with the contralateral nose wing height is basically the same, the shape of the nostril is basically symmetrical, while correction of columella skew, nasal collapse was greatly improved, the nasal shape basically coordinated, the effect is beautiful. The excellent and good rates of curative effect evaluation at 1, 6 and 12 months after operation were 98.6%, 97.4% and 97.1% respectively, with no significant difference (χ2 = 0.545, P = 0.761). Conclusion Self-costal cartilage carving lip cleft surgery nasal denervation individualized treatment, can achieve good surgical results.