关键词: 小耳畸形, &emsp, 外耳再造术, &emsp, 并发症, &emsp, 危险因素, &emsp, 预测, &emsp, 结构式与叙事疗法

Abstract: Objective To explore the related risk factors of complications after microtia external ear reconstruction and establish a predictive model， as well as the effect analysis of structural versus narrative therapy. Methods  Thirty-two patients who developed complications after microtia external ear reconstruction from January 2020 to December 2023 were selected as the complication group， and 153 patients who did not develop complications after microtia external ear reconstruction performed in the same period were selected as the non-complication group. The clinical data of the two groups were collected， the risk factors were evaluated using logistic regression model， the predictive value was assessed using the receiver operating characteristic （ROC） curve， and the decision tree model was constructed based on the risk factors. Meanwhile， 56 patients who underwent external ear reconstruction for microtia from March 2023 to December 2023 were selected as the control group， and conventional therapy was implemented， while 49 patients who underwent external ear reconstruction for microtia from January 2024 to September 2024 were selected as the observation group， and structural and narrative therapy was implemented. The two groups were compared in terms of psychological resilience， fear state and complication occurrence. Results  Logistic regression analysis showed that age ≥10 years （OR=6.709）， auricular malformation Max grade Ⅲ （OR=3.049）， atresia grade Ⅲ （OR=5.440）， having chronic diseases （OR=3.958）， intraoperative bleeding ≥50 mL （OR=5.029）， and admission time from April to September （OR=6.676） were independent risk factors for complications after microtia external ear reconstruction （P<0.05）. The ROC curves showed that age， Max grading of auricular deformity， atresia grading of the external auditory canal， chronic disease， intraoperative bleeding， admission time， and joint prediction were statistically significant in predicting the occurrence of complications after microtia external ear reconstruction （P<0.05）. Among them， the area under the curve（ AUC） of the joint prediction was 0.916， the 95% CI was 0.874-0.957， the sensitivity was 0.906， the specificity was 0.850， and the predictive value was relatively high. The decision tree model showed that grade Ⅲ of external auditory canal atresia grading was the most important predictor， and the classification accuracy of the model was 81.00%. After the intervention， the psychological resilience scale （CD-RISC） score of the observation group was higher than that of the control group （P<0.05）， and the children′s medical fear scale （CMFS） score was lower than that of the control group（ P<0.05）. The complication rate of 2.04% in the observation group was significantly lower than 12.50% in the control group （P<0.05）. Conclusion Age ≥10 years old， auricular deformity Max grading grade Ⅲ， external auditory canal atresia grading grade Ⅲ， chronic diseases， intraoperative bleeding ≥50 mL， and admission time from April to September were independent risk factors for complications after external ear reconstruction for microtia. In addition， structural and narrative therapy interventions are more effective， can improve the psychological state of patients and reduce the complication rate， which is worthy of clinical promotion and application.

Key words: Microtia, &emsp, External ear reconstruction, &emsp, Complications, &emsp, Risk factors, &emsp, Prediction, &emsp, Structural versus narrative therapy