5岁以下腭裂患儿术后腭咽闭合功能变化规律的研究

Changes of postoperative velopharyngeal function in children with cleft palate under 5 years old

目的探讨低龄腭裂患儿术后腭咽闭合功能恢复规律,及与年龄、腭裂类型和不同复诊时间等因素的相关关系。方法本研究纳入有2次以上复诊记录的5岁以下腭裂患者,回顾其术后腭咽闭合功能的连续性评估结果,分别进行单因素和多因素logistic回归检验,分析术后腭咽闭合功能变化的规律及影响因素。结果共纳入165例患者,其中31例患者出现前后腭咽闭合功能不一致,即初次复诊判定为腭咽闭合不全(VPI)而在二次复诊转为腭咽闭合完全(VPC),占总数18.79%;134例患者前后复诊腭咽闭合功能一致。腭咽闭合功能前后一致的患者平均年龄显著小于不一致的患者。手术年龄越小,在初次复诊时,患者的腭咽闭合功能更容易达到稳定。患者在术后15、28、40个月时,腭咽闭合功能达到稳定的比例为80%、90%、95%。结论腭裂术后腭咽闭合功能的恢复是一个动态过程,早期的VPI可能发展为VPC,但VPC不会再转变为VPI。复诊时间是腭咽闭合功能评估结果前后一致性最重要的相关因素,选择合适的复诊时间,有利于获得稳定准确的腭咽闭合功能评估结果。

Objective To demonstrate the regularity of velopharyngeal function recovery after primary cleft palatoplasty and its correlation with different surgical procedures,ages,cleft types,and follow-up times.Methods Patients with cleft palate under 5 years old who had more than two follow-up records were included in this study,and consecutive evaluations of postoperative velopharyngeal function were performed.Univariate and multivariate logistic regression analysis were used to reveal the regularity of postoperative velopharyngeal function and the possible influencing factors.Results A total of 165 patients were included.Inconsistent functions of the velopharyngeal closure were observed in 31 patients,of which velopharyngeal insufficiency(VPI)in the first follow-up converted to velopharyngeal competence(VPC)in the second follow-up,accounting for 18.79%of the total,and 134 patients had consistent velopharyngeal function.The patients in the group who had consistent velopharyngeal function were younger than those in the group who were inconsistent,and the differences between the two groups were statistically significant.The younger the operation age,the patient’s velopharyngeal function was more likely to stabilize at the first follow-up.At the time of the first follow-up in 15,28,and 40 months,the probability that the patients had stable postoperative velopharyngeal function was 80%,90%,and 95%,respectively.Conclusion The recovery of velopharyngeal function after surgery is a dynamic process.The velopharyngeal status of patients can be converted from VPI to VPC.Meanwhile,VPC cannot switch to VPI.The follow-up time is the most important factor affecting the consistency of the evaluation of velopharyngeal function.Choosing appropriate follow-up time is the key to obtain the stable evaluation of velopharyngeal function.