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医学奇迹:前臂上再造的耳朵成功移植患者头部

2017-03-31 孙海华 中国青年报

昨日上午,西安交通大学第一附属医院举行新闻通气会,向媒体通报了该院开展的一项重大创新技术: 3月29日,郭树忠教授和舒茂国教授带领的整形美容颌面外科团队成功将前臂预制的耳朵移植到了患者头部。因为车祸,导致右侧头部严重外伤,经过抢救,患者吉某的生命保住了,但少了一只耳朵。吉某曾到多家医院就诊,接诊医师都束手无策。经多方打听,他在西安交大一附院找到了全国著名的耳再造专家、整形美容颌面外科的郭树忠教授。




30日上午,西安交通大学第一附属医院举行新闻通气会,向媒体通报了该院开展的一项重大创新技术: 3月29日,郭树忠教授和舒茂国教授带领的整形美容颌面外科团队成功将前臂预制的耳朵移植到了患者头部。

因为车祸,导致右侧头部严重外伤,经过抢救,患者吉某的生命保住了,但少了一只耳朵。

吉某曾到多家医院就诊,接诊医师都束手无策。经多方打听,他在西安交大一附院找到了全国著名的耳再造专家、整形美容颌面外科的郭树忠教授。

在整形美容外科领域工作了34年的郭树忠教授,是世界第二例、亚洲第一例换脸术的主刀医生。

据了解,由于外伤和先天发育异常导致的耳缺损患者在我国有50万人左右。为了给小耳、缺耳、无耳患者再造正常耳廓,郭树忠领导的团队经过多年技术革新,创造了目前的第四代耳再造技术。同时,结合3D打印技术,使再造耳部的细节更加逼真,耳部该有的沟沟坎坎都能够出现,可以“以假乱真”。每年,团队为500名左右的孩子再造耳朵。

由于吉某耳周的皮肤损失异常严重,无法采用传统的方法进行耳再造。舒茂国主任组织全科专家教授进行讨论,郭教授团队拟打破传统耳再造模式,另辟蹊径。4个月前,郭树忠教授团队为吉某在其前臂成功预制出一只耳朵,外形逼真,受到国内外媒体的广泛关注。经过4个月左右的恢复,吉某的前臂再造耳朵形态逼真并与前臂组织完全融合。

3月29日,经过精心的前期准备,一场汇聚全院多科室力量,耗费7个小时,从前臂再造耳成功移植至头部的手术在该院展开。

由于手术涉及到患者的再造耳血管吻合,在术前,郭树忠教授和舒茂国教授团队使用便携式血管探测仪,再次确认血管位置,用红色的笔在手臂上详细标记。据介绍,整台手术的重中之重是需要把前臂的耳朵带着皮下10多厘米长的桡动、静脉血管移植到头部和面动、静脉进行吻合,以确保前臂再造耳是“活的”。

紧接着加入的是麻醉团队。为确保患者2个部位的手术同步进行,麻醉团队不仅增加了人手,而且还实施了精准的麻醉方案。除常规的全身麻醉外,还采用多普勒超声引导下对前臂的臂丛神经、颈部的颈丛神经阻滞麻醉,减轻患者术后的疼痛。

上午10时40分,手术正式开始。郭树忠教授和舒茂国教授同时坐在手术床的2侧,同时开始前臂和头部的手术。

按照术前预判,郭树忠教授寻找皮下桡动、静脉血管。但在手术操作过程中,却发现由于患者以前做过有创手术,前臂的血管层次发生了变化,郭教授利用多年经验迅速解决层次不明的问题,探查到血管,仔细剥离。手术既要保证前臂的神经不受损伤,还要保证血管的完整性以便于移植,同时还需保留手臂神经,不影响患者手部的功能。

1个半小时后,郭树忠教授成功取出了前臂上的再造耳,并带有长度12cm桡动、静脉血管。另外一侧,舒茂国教授已把头部移植耳朵的位置及血管制备好,面动静脉制备完成等待移植。

接下来的难题,是血管的吻合。由于这3根血管直径非常细,整个血管吻合的过程必须借助显微镜完成,舒茂国教授负责这部分的工作。他需要在1.5mm口径的血管上缝合12针,一共是3根血管,1个动脉,2个静脉,只有保证血管通畅的情况下,才能保证移植耳的血供。

近1个小时的显微镜下缝合操作后,血管顺利吻合。此时,手术进程过了大半,但为了再造耳的成活,必须还要确保再造耳朵有血供,就是老百姓通常说的耳朵得是“活的”。此外,还要设法减少手术操作区域的瘢痕,采用美容缝合材料和技术进行缝合。

此时,再造已经移植到患者右侧头部。经过仪器探测,“咕咚、咕咚“的血流声非常清晰,再造耳内的血供情况正常,再造耳移植手术圆满成功。

今日的发布会上,郭树忠教授和舒茂国教授介绍:此次手术的难点,在于头部曾经严重损伤,部位很难找到合适的血管。并且,血管只有火柴杆粗细,需要在显微镜下放大十倍,用比头发丝细的缝线缝合10余针。在保证血管通畅的同时,还需要将耳朵移植到合适的位置,保证其处于合适的角度和大小,并具备逼真的外形,恢复其听力。

目前,患者生命体征平稳,正在监护室康复。经过两周左右的治疗、监测,保证新耳朵完全存活后,患者将重返工作单位,迎接新的人生旅程。

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    2017-05-14 1581edce61m

    外行看热闹,内行看门道

    0

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    2017-04-29 虈亣靌

    不错的方式,努力学习,刻苦专研,不断总结出来新经验。

    0

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    2017-04-27 虈亣靌

    学习一下谢谢分享

    0

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    2017-04-01 和小尚

    又是医学上的一大奇迹

    0

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    2017-03-31 ann y

    医学奇迹:前臂上再造的耳朵成功移植患者头部

    0

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    2017-03-31 万里江山一孤舟

    高手

    0

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