72例腭隐裂修复方式的回顾分析

Surgical treatment of submucous cleft palate: A review of 72 cases

目的:通过回顾性分析8年的腭隐裂修复治疗,寻求较合适的修复方法及修复时机。方法:1999年9月至2007年1月行腭隐裂修复的患者72例,男37例,女35例,年龄1～35岁,平均11.2岁。术后1个月复诊,检查伤口愈合情况,并进行语音评估。同时将72例患者按所接受的手术方法分为三组:Ⅰ组(腭成形术),Ⅱ组(改良咽后壁组织瓣转移术),Ⅲ组(腭咽成形术);按手术年龄将其分为:<4周岁;≥4周岁、<8周岁;≥8周岁三组,统计各组的构成比,及比较各组术后的腭咽闭合及语音情况。结果:术后穿孔的患者为3例(4.2%),69例患者术后接受了语音评估,1例(兰氏术后)仍遗留VPI。10例患者语音检测为正常(96.15%±2.11%),余58例患者腭咽闭合功能改善,但仍伴代偿性发音,需语音治疗。手术方式分组:Ⅰ组13例(18.1%),Ⅱ组46例(63.89%),Ⅲ组13例(18.1%);年龄分组:<4周岁7例(9.72%),≥4周岁、但<8周岁25例(34.72%),≥8周岁40例(55.56%)。<4周岁的患者采用腭成形术最多,占57.1%,≥4周岁、但<8周岁及≥8周岁的患者采用改良咽后壁组织瓣转移术的最多,各占68%,和70%。语音评估发现<4周岁组的患者术后正常语音的比例最高,占71.4%,其次是≥4周岁、但<8周岁组,正常语音的比例为该年龄组的19.2%,VP完全,有代偿性发音的占76.9%,而大年龄组(≥8周岁),均伴有代偿性发音而需语音治疗。结论:小年龄组(<4周岁)的腭隐裂修复术后语音效果较好,大年龄组(≥8周岁)的腭隐裂修复可首选咽成形术或腭咽成形术,术后须辅以语音训练,≥4周岁、但<8周岁的患者修复方式的选择可根据具体情况选用。

PURPOSE： To find an effective treatment approach of submucous cleft palate by reviewing the clinical data of 72 patients in the past 8 years, METHODS： 72 patients （37 males, 35 females, age ranged from 1 to 35 years with a mean age of 11.2 years） with submucous cleft palate were retrospectively reviewed from Sep,1999 to Jan, 2007. All cases took the oral examination and speech assessment 1 month after surgery, They were divided into three groups according to the surgical approaches： group I with palatoplasty, group Ⅱ with modified pharyngeal flap surgery, group Ⅲ with palatopharyngoplasty ;They were also divided into three groups according to ages： younger than 4-year-old;older than 4-year-old but younger than 8-year-old and older than 8-year-old. The speech outcome after treatment was analyzed between the different groups. RESULTS： Fistula occurred in the cases （4,2%） after operation, velopharyngeal incompetence （VPI） was present in one patient after palatoplasty, Good speech was obtained in 10 cases, adequate velopharyngeal closure was achieved in the remaining 58 cases still with compensatory errors, Of 72 patients, 13 cases （18.1%） were in group Ⅰ and Ⅲ, 46 cases（63,89%）in group Ⅱ.7（9,72%） of these patients were younger than 4-year-old, 25（34.72%）were older than 4-year-old but younger than 8-year-old, 40（55.56%） were over 8-year-old. 57.1% of younger than 4-year-old patients underwent palatoplasty, almost 70% of older than 4-year-old patients underwent modified pharyngeal flap surgery. Additionally, 71,4% of patients younger than 4-year-old obtained normal speech result, satisfied speech was obtained in only 19.2% of these patients who were older than 4-year-old but younger than 8-year-old, and the others required speech therapy. CONCLUSIONS： Primary palatoplasty is suggested for the patients with submucous cleft palate younger than 4-year-old with markedly improved speech outcomes.Primary pharygoplasty of palatopharyngoplasty followed with speech therapy is suggested for the patients older than 8 years old. The treatment protocol for the patients older than 4 year-old but younger than 8-year-old is suggested to be determined basely on the patients＇ condition.