软腭再成形术矫治腭咽闭合不全患者的临床效果研究

Surgical correction of velopharyngeal insufficiency in cleft palate patients with two procedures of reconstruction of radical intravelar veloplasties (IVVs)

目的探讨软腭再成形术矫治腭咽闭合不全的效果以及手术适应证。方法2014年1月至2017年12月,北京大学口腔医学院口腔医院口腔颌面外科收治的58例腭裂术后患者,年龄3~28岁,平均7.5岁。临床诊断为轻度至中度腭咽闭合不全,腭咽间隙<8 mm。1组(36例)用改良Furlow法进行软腭再成形手术,2组(22例)用Sommerald法扩大腭帆提肌解剖重建进行软腭再成形手术。两组患者性别和年龄差异无统计学意义(P>0.05)。术后随访6个月以上,手术前后进行语音评估、鼻咽镜检查、头颅侧位X线片检查评价腭咽闭合功能。比较手术前后软腭有效工作长度改变。结果两组患者腭咽闭合功能完全恢复分别达94.5%和95.5%,有效率94.8%。两组患者软腭再成形术后软腭有效工作长度分别延长(9.50±2.35) mm和(7.50±3.32) mm,手术前后比较差异有统计学意义(P<0.05)。58例患者未出现鼻腔呼吸道阻塞症状。结论改良Furlow法和Sommerlad法扩大腭帆提肌解剖重建软腭再成形术均能有效解剖重建腭帆提肌,显著延长软腭有效工作长度,改善患者腭咽闭合功能。

Objective To summarize the clinical outcomes of surgical correction of velopharygeal insufficiency (VPI) with two procedures of radical intravelar veloplsties, and to discuss the indication selection of surgical technique. Methods 58 cases of various cleft palate were speech evaluated and diagnosed as mild to moderate VPI, who aged from 3 to 28 years (mean age 7.5 years). Group I (36 cases) were performed surgery in the way of modified Furlow double-opposing Z-plasty. Group Ⅱ(22 cases) were performed surgery in the way of Sommerald radical IVV. All cases were followed up for 6 months to 1 year after surgery, with speech evaluation and objective examination of nasopharygoscopy and fixed position lateral X ray. The X-ray images of lateral view of velum was read through PACS image system. The effective work length of soft palate and the pharyngeal gap of the velum at rest and function were measured directly through PACS system. The data of each case before and after surgery were compared. Results 34 of 36 cases (94.50%) in modified-Furlow group and 21 of 22 cases (95.5%) in Sommerlad group finally recovered complete velopharyngeal closure. Compared between before and post operation, the effective work length of soft palate in modified Furlow group increased by 9.50±2.35 mm, the length in Sommerlad group increased by 7.50±3.32 mm. The differences were statistically significant by paired T test (P<0.001). None of all cases complained nasal airway obstruction. Conclusions Both types of radical IVVs are highly effective to be recommended for surgical correction of mild to moderate VPI. Strict selection of surgical indication and excellent surgical skill are necessary for good treatment outcomes.