摘要
目的探讨改良咽后壁瓣成形术矫治腭裂术后腭咽闭合不全的临床效果。方法回顾性分析2018年1月至2022年5月于北京大学口腔医院诊断为腭咽闭合不全的唇腭裂患者临床资料。结合现代腭裂软腭肌肉重建的理念和方法,对传统咽后壁瓣成形术进行改良,行改良咽后壁瓣手术矫治腭咽闭合不全。进行术前、后语音主观判听(分为无、轻度、中度、重度过高鼻音、鼻漏气)、鼻咽纤维镜检查(将腭咽闭合不全分为轻、中、重度)、头颅侧位X线片(静止位和发/i/音位)检查及鼻阻塞症状评估(NOSE)量表评分(分值越高表示症状越重)。统计分析术后腭咽闭合功能恢复情况、鼻通气情况,通过头颅侧位X线片测量手术前后静息软腭长度、有效工作长度和软腭抬高角度,并采用配对t检验进行比较,P<0.05为差异有统计学意义。结果共纳入83例患者,男性44例,女性39例,年龄(13.04±11.31)岁(4~53岁)。83例患者术后随访6~18个月,伤口均一期愈合,无术后出血、穿孔以及咽后壁瓣脱落现象;78例腭咽完全闭合,手术成功率为94.0%,3例术后仍存在轻度过高鼻音、鼻漏气,1例术后存在中度过高鼻音、鼻漏气,1例术后存在重度过高鼻音。头颅侧位X线片测量结果显示术前、后静息软腭长度[(29.27±6.01)mm vs.(36.88±6.51)mm]、软腭有效工作长度[(18.53±5.04)mm vs.(25.76±5.17)mm]、软腭抬高角度(11.42°±11.65°vs.15.91°±8.54°)比较,差异均有统计学意义(P<0.01)。鼻通气情况调查结果显示,98%(81/83)的患者于术后早期(1个月内)主观感受鼻通气障碍;术后早期与术后6个月以上NOSE量表评分比较[(8.61±3.64)分vs.(3.06±2.92)分],差异有统计学意义(P<0.01)。结论改良咽后壁瓣成形术矫治腭咽闭合不全可以显著增加软腭长度及软腭有效工作长度,提高软腭运动能力,实现腭咽功能重建,改善患者语音功能,取得较好的手术效果。
ObjectiveTo evaluate the clinical effect of modified posterior pharyngeal flap surgery in the treatment of velopharyngeal insufficiency.MethodsClinical data of patients with cleft lip and palate diagnosed with velopharyngeal insufficiency and undergoing modified posterior pharyngeal flap surgery in Peking University School and Hospital of Stomatology from January 2018 to May 2022 were retrospectively analyzed.The traditional posterior pharyngeal flap surgery was improved by combining the modern concept and method of soft palate muscle reconstruction,and performed modified posterior pharyngeal flap surgery to correct velopharyngeal insufficiency.Preoperative and postoperative follow-up were performed including speech evaluation(classifying as none,mild,moderate,moderate to severe hypernasality and nasal emission),nasopharyngeal fiberscope(classifying velopharyngeal insufficiency as mild,moderate,or severe),lateral cephalometric radiographs(resting position and/i/position),and the Nasal Obstruction Symptom Evaluation(NOSE)scale.The recovery of velopharyngeal function and nasal ventilation after the operation were statistically analyzed.The difference of resting velar length(RVL),effective working length(EWL)and angel of velar lifting(AVL)before and after the operation was compared by paired t-test to evaluate the clinical effect of surgery.P<0.05 indicates a statistically significant difference.ResultsA total of 83 patients with velopharyngeal insufficiency were enrolled,including 44 males and 39 females,aged(13.04±11.31)years(4-53 years).83 patients were followed up for 6-18 months after surgery,and all patients had primary wound healing without postoperative bleeding,perforation,or posterior pharyngeal flap detachment;78 cases achieved complete velopharyngeal closure,the surgical success rate was 94%,three patients still had mild hypernasality and nasal emission after surgery,one patient still had moderate hypernasality and nasal emission after surgery,and one patient had severe hypernasality after surgery.The R
作者
罗岚瑞
杨爽
周侠
杜长江
蔡志刚
朱洪平
Luo Lanrui;Yang Shuang;Zhou Xia;Du Changjiang;Cai Zhigang;Zhu Hongping(Department of Oral and Maxillofacial Surgery,Peking University School and Hospital of Stomatology&National Center for Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Research Center of Oral Biomaterials and Digital Medical Devices,Beijing 100081,China)
出处
《中华整形外科杂志》
CSCD
北大核心
2024年第8期857-865,共9页
Chinese Journal of Plastic Surgery
基金
国家临床重点专科建设项目(PKUSSNMP-201903)。
关键词
腭咽闭合不全
腭裂
咽后壁瓣
头颅侧位片
软腭功能
Velopharyngeal insufficiency
Cleft palate
Posterior pharyngeal flap
Lateral cephalometric radiographs
Soft palate function
