Muzaffar A R, Byrd H S, Rohrich R J, Johns D F, LeBlanc D, Beran S J, Anderson C, Papaioannou aA A
Department of Plastic Surgery, University of Texas Southwestern Medical Center/Children's Medical Center, Dallas, Texas 75235-9132, USA.
Plast Reconstr Surg. 2001 Nov;108(6):1515-8. doi: 10.1097/00006534-200111000-00011.
The purpose of this study was to determine the incidence of cleft palatal fistula in a series of nonsyndromic children treated at the authors' institution. This retrospective analysis of 103 patients with cleft palate treated by five surgeons between 1982 and 1995 includes 60 boys and 33 girls, whose median age was 18.4 months at the time of surgery. The median length of follow-up was 4.9 years after primary palatoplasty. Cleft palatal fistula was defined as a failure of healing or a breakdown in the primary surgical repair of the palate. Intentionally unrepaired fistulas of the primary and secondary palate were excluded. Extent of clefting was described according to the Veau classification. Statistical examination of multiple variables was performed using contingency table analysis, multivariate logistic regression, and the Wilcoxon rank sum test. The incidence of cleft palatal fistula in this series was 8.7 percent. All of these fistulas were clinically significant. The rate of fistula recurrence was 33 percent. The incidence of cleft palatal fistula when compared by Veau classification was statistically significant, with nine fistulas occurring in patients with Veau 3 and 4 clefts and no fistulas occurring in patients with Veau 1 and 2 clefts (p = 0.0441). No significant differences between patients with and without fistulas were identified with respect to operating surgeon, patient sex, patient age at palatoplasty, type of palatoplasty, and use of presurgical orthopedics or palatal expansion. All three recurrent fistulas occurred in the anterior palate, two in patients with Veau class 3 clefts and one in a patient with a Veau class 4 cleft. The low rate of clinically significant fistula was attributed to early delayed primary closure, with smaller secondary clefts allowing repair with a minimum of dissection and disruption of vascularity.
本研究的目的是确定在作者所在机构接受治疗的一系列非综合征性儿童中腭裂瘘的发生率。对1982年至1995年间由五位外科医生治疗的103例腭裂患者进行的这项回顾性分析，包括60名男孩和33名女孩，他们在手术时的中位年龄为18.4个月。初次腭裂修复术后的中位随访时间为4.9年。腭裂瘘被定义为腭部初次手术修复愈合失败或裂开。原发性和继发性腭部故意未修复的瘘被排除在外。根据韦氏分类法描述腭裂程度。使用列联表分析、多变量逻辑回归和威尔科克森秩和检验对多个变量进行统计学检验。该系列中腭裂瘘的发生率为8.7%。所有这些瘘在临床上都具有重要意义。瘘复发率为33%。按韦氏分类法比较时，腭裂瘘的发生率具有统计学意义，韦氏3级和4级腭裂患者中有9例发生瘘，而韦氏1级和2级腭裂患者中未发生瘘（p = 0.0441）。在手术医生、患者性别、腭裂修复术时的患者年龄、腭裂修复术类型以及术前正畸或腭部扩展的使用方面，有瘘和无瘘患者之间未发现显著差异。所有三例复发性瘘均发生在腭前部，两例发生在韦氏3级腭裂患者中，一例发生在韦氏4级腭裂患者中。临床上有重要意义的瘘发生率低归因于早期延迟一期关闭，较小的继发性腭裂允许在最少的解剖和血管破坏情况下进行修复。
