两种软腭内成形腭裂整复术疗效比较

Comparison of two palatoplasty with intravelar veloplasty technique in children with cleft palate

目的:比较传统的软腭内成形腭裂整复术(TIVV)与彻底的软腭内成形腭裂整复术(RIVV)对2岁以上腭裂患者的治疗效果,为其最适治疗方案的选择提供参考。方法:回顾性分析1985年至2013年四川大学华西口腔医院收治的220例初期软腭内成形腭裂整复术患者的临床资料,按照手术方式不同分为TIVV组(95例)和RIVV组(125例)。对2组患者术后腭咽闭合不全发生率及腭瘘发生率进行比较,并对影响手术效果的因素进行分层分析及logistic多因素分析。结果:TIVV组与RIVV组术后腭咽闭合不全发生率及腭瘘发生率差异均无统计学意义(P>0.05)。RIVV组中,2~5岁组的腭咽闭合不全发生率低于≥5岁组,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,手术年龄是手术效果重要的影响因素(OR=1.107,95%CI=1.037~1.181,P=0.002)。TIVV亚组logistic回归分析显示以上因素均不影响其手术效果;RIVV亚组logistic回归分析显示,手术年龄是手术效果的影响因素(OR=1.102,95%CI=1.025~1.185,P=0.009)。结论:两种软腭内成形腭裂整复术对2岁以上腭裂患者的治疗效果没有显著性差异,RIVV可能更适合2~5岁的学龄前期患儿。

Objective:To compare the clinical effect of two palatopalasty techniques with traditional and radical intravelar veloplasty for children older than 2 years old with cleft palate.Methods:The clinical data of 220 patients after primary palatoplasty in West China Stomatology Hospital of Sichuan University from 1985 to 2013 were retrospectively analyzed.The incidence of postoperative velopharyngeal insufficiency and palatal fistula were compared between the two groups.Meanwhile,the factors associated with velopharyngeal insufficiency were analyzed by hierarchical analysis and multiple logistic regression analysis.Results:There was no significant difference between the two study groups in the rate of velopharyngeal insufficiency and oronasal fistula(P>0.05).Nevertheless,in the RIVV group,the rate of velopharyngeal insufficiency of 2-to-5-year group was significantly lower than the group≥5 years old(P<0.05).Logistic regression analysis showed that age at palatoplasty was the only most important risk factor of velopharyngeal insufficiency(OR=1.107,95%CI=1.037-1.181,P=0.002).Logistic regression analysis of TIVV subgroup showed no risk factor of velopharyngeal insufficiency.Furthermore,logistic regression analysis of RIVV subgroup showed that age at palatoplasty was the risk of VP insufficiency(OR=1.102,95%CI=1.025-1.185,P=0.009).Conclusion:The radical intravelar veloplasty was not significantly superior to the traditional intravelar veloplasty for cleft palate children older than 2 years.Moreover,the RIVV technique may be more suitable for those aged 2 to 5 years old.