两种术式对大龄腭裂患儿术后瘘发生率及语音清晰度改善的影响

Effects of Two Kinds of Operation on the Incidence of Postoperative Fistula and Speech Intelligibility in Older Children with Cleft Palate

目的探讨腭帆单纯提肌重建以及腭帆提肌重建联合带蒂颊脂垫瓣和咽后壁瓣两种术式,对大龄腭裂患儿术后瘘发生率及语音清晰度的影响。方法 60例大龄腭裂患儿(4~9岁),随机分为2组,分别予以单纯腭帆提肌重建(A组)及腭帆提肌重建联合颊脂垫瓣和咽后壁瓣修复(B组),观察并比较术后腭瘘的发生率及语音清晰度情况。结果术后A组瘘发生率明显高于B组(P<0.05);两组术后语音清晰度均较术前提高(P<0.05),且B组优于A组(P<0.05);腭部瘢痕情况B组优于A组(P<0.05)。结论对于大龄腭裂患儿,腭帆提肌重建联合咽后壁瓣及带蒂颊脂垫瓣的术式有效降低了腭瘘的发生率,可获得更好的语音清晰度,并可避免裸露骨面,减少腭部瘢痕形成及对上颌骨生长发育的影响,是一种值得推荐的功能性腭裂修复术式。

Objective To explore the effects of two kinds of operation(levator veli palatini retropositioning&levator veli palatini retropositioning combined with buccal fat pad flap and pharyngeal flap)on the incidence of fistula and speech intelligibility in older children with cleft palate.Methods Sixty cases with cleft palate(4 to 9 years old)were divided into 2 groups randomly,and were treated with levator veli palatini retropositioning(group A)and levator veli palatini retropositioning combined with buccal fat pad flap and pharyngeal flap(Group B)respectively.The incidence of palatal fistula and speech intelligibility in the 2 groups were observed and compared.Results The incidence of fistula in group A was higher than in group B(P<0.05).The speech intelligibility was improved in both group A and group B(P<0.05).The speech intelligibility and scar formation in group B was both better than in group A(P<0.05).Conclusion For older children with cleft palate,levator veli palatini retropositioning combined with buccal fat pad flap and pharyngeal flap can reduce the incidence of palatal fistula effectively,and also can obtain better speech intelligibility.Since this method can avoid bone exposure,so as to reduce scar formation and the effect on maxillary growth,it is a functional cleft palate repair method and worthy to be recommended.