目的：研究先天性小耳畸形患者的耳郭再造术中Nagata（两期法）耳郭再造术在临床应用中的改进，以便更好的满足中国小耳畸形患者及家属需求，提供减少创伤及痛苦，提高安全性及效果的治疗方案。

方法：自2015年1月至2016年1月，共收治584例先天性小耳畸形患者，左侧小耳畸形254例，右侧小耳畸形312例；其中男性385例，女性199例；最小年龄6岁，最大年龄14岁，平均年龄7.60±2.56岁。通过术前局部软组织条件评估，选取了228例患者行Nagata（两期法）耳郭再造术，手术分两期完成,一期手术：肋软骨采取，耳支架雕刻，耳支架植入，耳垂转位，耳屏再造术；二期手术为颅耳角成形，耳后筋膜瓣覆盖，中厚植皮术。

结果：Nagata（两期法）耳郭再造术的228例，术后随访6个月至16个月，平均8.3个月。通过门诊、电话、微信平台等方法进行随访，对再造耳郭及手术进行整体的评估，本组患者术后再造耳郭评分优秀者（15分-20分）167例，良好者（8分-14分）28例，差者（0分-7分）9例，24例没有获得随访，优良率为95.5%。本组患者共出现并发症5例，积极处理后均好转。第一期并发症为血肿3例，1例在清洁换药室内清除后恢复，2例有活动性出血，在手术室内清除血肿并重新止血；二期手术并发症主要为：耳后植皮成活不良、耳支架外露。本组患者耳后植皮成活不良者1例，经换药后愈合；耳轮上1/3处软骨外露者1例，采用颞顶筋膜瓣通过皮下隧道覆盖在外露的耳软骨处，筋膜表面游离植皮，术后恢复良好。

结论：在将Nagata（两期法）耳郭再造技术运用于我国实际中，我们根据临床工作中的思考和患者及家属的需求，对Nagata（两期法）技术进行了改良。 通过对手术指征的把握以及对肋软骨支架雕刻技术的改进和肋软骨采取方法的更新，满足了患者及家属入学前手术的要求；减少了头皮的瘢痕；降低了肋软骨需求量，减小了对胸廓形态的影响；更好的凸显了耳轮、对耳轮、耳屏等解剖结构，提高了患者对再造耳形态的满意度。

Objective: The Nagata （two stage）method in Auricular reconstruction  improvement in clinical application, in order to better meet the demand of microtia patients and their families in Chinese, offer less trauma and pain, improve the safety and effect of the treatment plan.

Methods: From January 2015 to January 2016, a total of 584 patients with congenital microtia malformation were treated, microtia on the left side of the 254 cases, the right side of the microtia 312 cases; A total of 385 of the patients were male, and 199 were female, ranging in age from 6 to 14 years with an average of 7.60±2.56 years old. By preoperative local soft tissue condition assessment, selected the 106 cases of patients the Nagata （two stage）method, completed in two phases: the costal cartilage was harvested and the framework was fabricated，The earlobe transposition and The tragus reengineering; Second stage surgery for cranial ear forming Angle，ear fascia flap coverage, medium thickness skin grafting.

Results: The latest 228 cases choose The Nagata （two stage）method in Auricular reconstruction, were followed up for 6 months to 16 months, an average of 8.3 months. By methods of outpatient service, telephone follow-up, the reengineering ear and overall assessment of the operation, are very satisfied with this group of patients with postoperative follow-up (15-20) of 167 cases with 28 cases (8 to 14), not satisfied (0 to 7) 9 cases, 24 cases received no follow-up, satisfaction rate of 95.5%. This group of patients with a total of 5 cases happen complications, all were restored after treatment. First stage complications is hematoma; Groups of 3 patients with postoperative hematoma, 1 case after clean dressing indoor recovery, 2 case with active bleeding, in the operating room to remove the hematoma and to stop bleeding; second stage complications mainly for: after ear skin graft survival, ear holder leakage. This group of patients after ear skin graft survival were 1 case, after dressing the healing; Ear cartilage constructs the leakage in 1 cases, Helix 1/3 cartilage on the leakage in 1 case, use the temporoparietal fascia flap covering the outer ear cartilage of leakage through the subcutaneous tunnel, fascia surface free skin graft, recovering well after surgery.

Conclusion: The ear reengineering with the Nagata （two stage） technology applied to the practice in our country, we according to the requirements of the patient and family to redesign the Nagata （two stage） technology. Pass the assurance of pair of surgical indications and the improvements of rib cartilage engraving technology and adopt method of rib cartilage renewal, meet the requirements of the patient and family to school before surgery. Reduce the scalp and chest scar; Reduces the demand of rib cartilage, better avoid thoracic deformity; Better highlight the helix, antihelix and tragus anatomical structure, improved the shape of the ear reconstruction in patients with satisfaction.