Sommerlad腭帆提肌重建术修复不完全腭裂后创面愈合情况的研究

STUDY ON WOUND HEALING AFTER Sommerlad TECHNIQUE REPAIR OF ISOLATED CLEFT PALATE

目的 通过与Von Langenbeck法比较,分析Sommerlad腭帆提肌重建术修复不完全腭裂术后创面愈合的情况,探讨该术式对上颌生长抑制的影响。方法 以2005年6月-2011年8月,采用Sommerlad腭帆提肌重建术修复的54例不完全腭裂患儿作为试验组;2003年6月-2006年9月,采用Von Langenbeck法修复的89例患儿作为对照组。两组患儿性别、年龄比较,差异均无统计学意义（P〈0.05）,具有可比性。比较两组手术时间、术中出血量、术后体温及发热情况;随访腭部创面愈合情况,按照Karsten等的腭裂术后腭部瘢痕愈合分级标准进行分级。结果 试验组手术时间为（72.2±5.5）min,较对照组（58.1±6.8）min延长;术中出血量为（18.6±6.5）mL,较对照组（34.2±10.2）mL显著减少;差异均有统计学意义（t=4.494,P=0.000;t=2.447,P=0.000）。术后48 h内试验组患儿最高体温为36.6～37.6℃,平均36.9℃,其中发热5例（9.3%）;对照组为36.8～38.2℃,平均37.3℃,其中发热21例（23.6%）;两组比较差异有统计学意义（χ2=4.64,P=0.03）。两组患儿术后均获随访,其中试验组随访时间3～18个月,平均9个月;对照组随访3～6年,平均4年。术后3个月根据Karsten等的腭裂术后腭部瘢痕愈合分级标准,试验组0级38例、1级13例、2级3例,对照组0级6例、1级35例、2级48例,比较差异有统计学意义（Z=—7.785,P=0.000）。结论 与Von Langenbeck法相比,Sommerlad腭帆提肌重建术修复不完全腭裂创伤小、术后瘢痕愈合轻,提示对上颌生长抑制影响较小。

Objective To study the inhibitory effect of Sommerlad technique on the growth of the maxilla by comparing the wound healing between Sommerlad and Von Langenbeck techniques in repair of isolated cleft palate. Methods A retrospective cohort study was conducted on 54 patients with isolated cleft palate who received palatoplasty with levator veli palatini retropositioning according to Sommerlad between June 2005 and August 2011 as trial group; 89 cleft patients received Von Langenbeck technique repair between June 2003 and September 2006 as control group. There was no signii cant dif erence in gender and age between 2 groups（P〉0.05）. The operation time, intraoperative blood loss, body temperature, and fever were recorded and compared; the wound healing was observed, and the palatal mucosa was graded according to Karsten standard. Results The operation time of trial group [（72.2 ± 5.5） minutes] was signii cantly longer than that of control group [（58.1 ± 6.8） minutes]（t=4.494, P=0.000）; the intraoperative blood loss of trial group [（18.6 ± 6.5） mL] was signii cantly less than that of control group [（34.2 ± 10.2） mL]（t=2.447, P=0.000）. Within postoperative 48 hours, the highest body temperature was 36.6-37.6℃（mean, 36.9℃） in trial group, and was 36.8-38.2℃（mean, 37.3℃） in control group; fever occurred in 5 patients（9.3%） of trial group and 21 patients（23.6%） of control group, showing signii cant dif erence（χ2=4.640, P=0.030）. The patients were followed up 3-18 months（mean, 9 months） in the trial group, and 3-6 years（mean, 4 years） in the control group. Scar was rated as level 0, level 1, and level 2 in 38, 13, and 3 cases of trial group, and in 6, 35, and 48 cases of control group, showing signii cant dif erence（Z= —7.785, P=0.000）. Conclusion The isolated cleft palate repair using Sommerlad technique has the advantages of less injury and less scar tissue, indicating no inhibitory ef ect on the growth of the maxilla.