明胶海绵在腭裂修复中的应用

Clinical use of gelatin sponge in palatorrhaphy

背景:在腭裂修复手术中,以往多采用碘仿纱条来填塞腭裂术后两侧松驰切口及覆盖创面。临床中作者发现,采用这种方法处理的患者,术后常出现发热、食欲不振、异物感、继发性出血等并发症。为避免或减少腭裂患者术后出现以上并发症,使用明胶海绵填塞双侧松弛切口,取得了良好的临床效果。目的:对比腭裂患者修复术中创面不同处理方法对伤口愈合效果的影响。方法:根据患儿入院时间,将110例腭裂手术患儿分为2组:2013年1月至2015年12月入院腭裂患儿54例为实验组,2008年1月至2012年12月入院腭裂患儿56例为对照组。实验组采用明胶海绵填塞创面,对照组应用碘仿纱包及碘仿纱条填塞创面,评估患儿术后精神、饮食、体温、创口出血及愈合等情况。术后4周复查,测量患者松弛切口处瘢痕条索宽度。结果与结论:(1)实验组精神、饮食恢复时间和出院时间短于对照组(P<0.05);(2)实验组发热率明显低于对照组(P<0.05),且发热时间短于对照组(P<0.05);(3)实验组术后出血、恶心呕吐发生率明显低于对照组,差异有显著性意义(P<0.05);(4)术后4周,实验组患儿松弛切口处瘢痕条索宽度明显窄于对照组,差异有显著性意义(P<0.05);(5)结果表明,明胶海绵止血可靠,术后反应轻,伤口愈合快,不影响进食,具有较好的临床应用价值。

BACKGROUND： In palatorrhaphy, iodoform gauzes are often used to fill the bilateral relaxation incisions and cover the wound. However, there are a series of postoperative complications, such as fever, loss of appetite, foreign body sensation, secondary bleeding. In order to avoid or reduce the complications after palatorrhaphy, theuse of gelatin sponge to fill bilateral relaxation incisions has achieved good clinical results. OBJECTIVE： To compare the clinical effects of different treatments on wound healing after palatorrhaphy. METHODS： 110 child patients with cleft palate were selected and assigned into two groups according to admission time. Fifty-four patients who admitted from January 2013 to December 2015（experimental group） were obturated with gelatin sponge, while the other 56 patients who admitted from January 2008 to December 2012（control group） were obturated with idoform gauze. The postoperative results of patients were assessed in various aspects, including psychological impact, diet, body temperature, bleeding, and wound healing. The incision scar width was measured at 4 weeks postoperatively. RESULTS AND CONCLUSION：（1） Patients in the experimental group experienced shorter recovery time than those in the control group（P〈0.05）.（2） Patients in the experimental group had substantially lower incidence of fever postoperatively, and shorter duration of fever than those in the control group（P〈0.05）.（3） In comparison to the control group, the experimental group showed less postoperative complications such as bleeding and vomiting（P〈0.05）.（4） The incision scar width in the experimental group was significantly narrower than that in the control group（P〈0.05） after 4 weeks. These experimental findings demonstrate the superior effect of gelatin sponge over iodoform gauze and its value in clinical application with better healing, less bleeding, shorter recovery time and no impact on eating.