Cronin E D, Williams J L, Shayani P, Roesel J F
Plastic Surgery Residency Program, Christus St. Joseph Hospital, Houston, Texas, USA.
Plast Reconstr Surg. 2001 Sep 15;108(4):838-40; discussion 841. doi: 10.1097/00006534-200109150-00003.
Although algorithms for the repair of soft and hard palatal clefts continue to be debated, the appropriate length of postoperative stay has not yet been defined. Recent reports of cleft palate repair advocate a 2- to 5-day hospitalization. The plastic surgery service at St. Joseph Hospital frequently uses same-day admission with 23-hour observation postoperatively, with no increase in complications from the reported 2- to 5-day stay. The authors inspected the records for all the cleft palate patients undergoing cleft repair at St. Joseph Hospital Cleft Clinic from August of 1988 through June of 1998. After excluding syndromic patients and secondary or revision surgical cases, 79 patients remained in the study. These 79 patients underwent 104 procedures; all procedures were performed by a single surgeon (E.D.C.) with resident assistance. Short-term morbidity, length of stay, and operation performed were studied. All patients were admitted the day of surgery. Mean age at the time of operation was 13.2 months, with a range of 6 months to 20 years. The length of operation averaged 1 hour and 37 minutes; 94 percent of patients stayed 24 hours or less postoperatively, and 97 percent stayed 36 hours or less. The longest stay was 72 hours, which was related to delay in resuming adequate oral intake. The overall complication rate was 3.8 percent for this cohort, which included two partial palatal dehiscences and two small fistulas. No blood transfusions were needed, and no infections were noted postoperatively. No patients required readmission postoperatively for bleeding, respiratory compromise, or inadequate oral intake. The authors do not advocate a 1-night stay for all cleft palate cases. However, they do think it is safe for a healthy group of patients undergoing routine cleft palate surgery. The decision to discharge a patient early must always be left to the treating physician.
尽管软硬腭裂修复算法仍存在争议，但术后的合适住院时长尚未明确。近期有关腭裂修复的报告主张住院2至5天。圣约瑟夫医院的整形手术科室经常采用当日入院并术后观察23小时的方式，且并发症并未比报告的2至5天住院情况有所增加。作者查阅了1988年8月至1998年6月期间在圣约瑟夫医院腭裂诊所接受腭裂修复的所有患者记录。排除综合征患者以及二次手术或翻修手术病例后，79名患者纳入研究。这79名患者共接受了104次手术；所有手术均由一名外科医生（E.D.C.）在住院医生协助下完成。对短期发病率、住院时长和所实施手术进行了研究。所有患者均在手术当天入院。手术时的平均年龄为13.2个月，范围为6个月至20岁。手术时长平均为1小时37分钟；94%的患者术后住院24小时或更短时间，97%的患者住院36小时或更短时间。最长住院时间为72小时，这与恢复充足经口摄入量延迟有关。该队列的总体并发症发生率为3.8%，其中包括两例部分腭裂裂开和两例小瘘管。无需输血，术后未发现感染情况。没有患者因出血、呼吸功能不全或经口摄入量不足而术后需要再次入院。作者并不主张所有腭裂病例均住院一晚。然而，他们确实认为对于接受常规腭裂手术的健康患者群体而言是安全的。患者提前出院的决定始终应留给主治医生。
