腭裂整复术117例临床病例分析

Clinical Analysis of 117 Cases in Cleft Palate Repair

目的:探讨117例腭裂患者修复术式的运用、并发症的处理、预后以及初步语音训练的效果。方法:选择117例腭裂患者为研究对象,以两瓣法作为基本术式,根据腭裂的临床分型适时选择腭帆提肌重建等方式进行腭裂整复,定期随访,并在2年后对患者进行语音清晰度的评估。结果:117例患者均手术顺利,术后无活动性出血、呼吸道梗阻及创口感染。其中115例腭垂形态较好,软腭活动度良好;出现并发症2例,皆为穿孔。测试的69例患者语音清晰度平均为61.7%,高年龄组(8～38岁)患者语音清晰度改善状况与低年龄组(4～8岁)之间存在显著性差异(P<0.05)。结论:在将安全放在首要位置,注重软腭肌肉功能重建的基础上,实施腭裂整复术后患者的腭咽闭合恢复较好,并发症出现较少。低年龄组语音清晰度改善优于高年龄组,但自行训练的语音清晰度改善不理想。

Objective： To discuss the clinical practice of cleft palate repair on options of operative methods,management of complications,prognosis,and primary speech training.Methods： 117 patients with cleft palate were included in the study.Based on two-flap palatoplasty,different methods for palatoplasty were applied according to the patient＇s classification of cleft palate and were regularly followed up.Their speech intelligibility was evaluated at the end of second year.Results： 117 patients had been repaired successfully without postoperative active bleeding,airway obstruction and wound infection.115 patients showed normal contour of uvula and good velar movement,but 2 were complicated with palatal fistula.The average speech intelligibility of 69 tested patients was 61.7%.The older age group（8~38 years） showed a significant difference compared with the younger age group（4~8 years）（P0.05）.Conclusions： It is better for velopharyngeal closure based on safety first and the levator veli palatini muscle retropositioning.Better speech intelligibility is shown in the younger age group than in the older one,but the improvement of speech intelligibility exercised by patients themselves were not satisfied.