Kirschner Richard E, Low David W, Randall Peter, Bartlett Scott P, McDonald-McGinn Donna M, Schultz Patricia J, Zackai Elaine H, LaRossa Don
Division of Plastic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Cleft Palate Craniofac J. 2003 Jan;40(1):13-8. doi: 10.1597/1545-1569_2003_040_0013_samipr_2.0.co_2.
The purpose of this study was to examine the efficacy of tongue-lip adhesion (TLA) in the management of clinically significant airway obstruction associated with Pierre Robin sequence.
The records of all children admitted to The Children's Hospital of Philadelphia with a diagnosis of Pierre Robin sequence were reviewed. Charts were reviewed for birth data, diagnosis, preoperative airway management methods, and surgical intervention. Records of infants undergoing TLA were analyzed for timing of surgery, operative technique, postoperative complications, length of hospital stay, and treatment outcome.
Over the 28-year period 1971 to 1999, 107 patients (47 boys, 60 girls) meeting the criteria for Pierre Robin sequence were admitted for treatment. Of these, 74 (69.2%) were successfully managed by positioning alone. Surgical management of the airway was performed in the remaining 33 (30.8%) patients, 29 of whom underwent TLA and 4 of whom underwent tracheostomy. Dehiscence of the adhesion occurred in five patients (17.2%), two of whom subsequently required tracheostomy. Within the group of patients who underwent mucosal adhesion alone, the dehiscence rate was 41.6%. When the adhesion included muscular sutures, however, dehiscence was not observed in any patient. Of the 24 patients in whom primary TLA healed uneventfully, airway obstruction was successfully relieved in 20 (83.3%). Failure of a healed TLA to relieve the airway obstruction resulted in conversion to a tracheostomy in four patients. Six patients who underwent TLA (20.7%) ultimately required a tracheostomy; five of these patients (83.3%) were syndromic. Of patients requiring preoperative intubation, 42.9% ultimately required tracheostomy.
TLA successfully relieves airway obstruction that is unresponsive to positioning alone in the majority of patients with Pierre Robin sequence and should therefore play an important role in the management of these infants.
本研究旨在探讨舌唇粘连术（TLA）在治疗与皮埃尔·罗宾序列征相关的具有临床意义的气道阻塞中的疗效。
回顾了所有入住费城儿童医院且诊断为皮埃尔·罗宾序列征的儿童的病历。查阅病历以获取出生数据、诊断、术前气道管理方法和手术干预情况。分析接受TLA手术的婴儿的手术时间、手术技术、术后并发症、住院时间和治疗结果。
在1971年至1999年的28年期间，107例符合皮埃尔·罗宾序列征标准的患者（47例男孩，60例女孩）入院接受治疗。其中，74例（69.2%）仅通过体位调整成功治疗。其余33例（30.8%）患者进行了气道手术治疗，其中29例接受了TLA手术，4例接受了气管切开术。5例患者（17.2%）出现粘连裂开，其中2例随后需要进行气管切开术。在仅接受黏膜粘连的患者组中，裂开率为41.6%。然而，当粘连包括肌肉缝合时，未观察到任何患者出现裂开。在24例一期TLA愈合良好的患者中，20例（83.3%）气道阻塞得到成功缓解。TLA愈合后未能缓解气道阻塞导致4例患者改行气管切开术。6例接受TLA手术的患者（20.7%）最终需要进行气管切开术；其中5例（83.3%）患有综合征。在需要术前插管的患者中，42.9%最终需要进行气管切开术。
TLA成功缓解了大多数皮埃尔·罗宾序列征患者中对单纯体位调整无反应的气道阻塞，因此应在这些婴儿的治疗中发挥重要作用。
