Osorio A, Moreira-Pinto J, Oliveira L, Ferreira-de-Sousa J A, Cidade-Rodrigues J A
Centro Hospitalar do Porto-Unidade Maria Pia, Department of Pediatric Surgery, 827 Rua da boavista, Oporto, Portugal.
Eur J Pediatr Surg. 2009 Dec;19(6):377-9. doi: 10.1055/s-0029-1241173.
Drooling is common in children with neurological disabilities (ND), and constitutes an additional burden with many medical complications in an already socially disadvantaged patient. This study aims to evaluate the effectiveness of bilateral submandibulectomy (BS) to treat drooling with regard to the parental satisfaction grade, complications and recurrence of drooling in children with ND.
PATIENTS/MATERIAL AND METHODS: A retrospective study was performed of all children with ND and drooling who underwent BS in our Department between January 1996 and November 2008. Data were taken from surgical records and patient files. Parental satisfaction was graded into four classes: A: 75-100% satisfaction (infrequent drooling, small amounts; absence of drooling); B: 50-75% satisfaction (occasional drooling, on and off all day; infrequent drooling, small amounts); C: 25-50% satisfaction (frequent drooling, but not profusely; occasional drooling, on and off all day); D: 0-25% satisfaction (constant drooling, always wet; frequent drooling, but not profusely).
BS was performed in 85 patients (38% male; 62% female; median age, 9 years). 35 patients had to be excluded from our study because their medical records were unavailable. Only 3 out of the remaining 50 patients had recurrence. Parental satisfaction grade (PSG) was A in 26 cases (55.3%); B in 15 (31.9%); C in 3 (6.4%) and D in 3 (6.4%). The first follow-up was usually 1 week after surgery (median, 2 weeks). The incidence of post-surgery complications was 4% and all complications were minor.
DISCUSSION/CONCLUSIONS: Assessment of the results achieved was subjective as it was not possible to quantify the amount of drooling precisely before/after surgery. Nevertheless, BS was found to be an easy and safe procedure as the low rate of complications demonstrates. It was also found to be an effective procedure; there were only 3 recurrences, and PSG in 87.2% of cases was either A or B, indicating a minimum improvement in drooling of 50%.
流涎在患有神经功能障碍（ND）的儿童中很常见，这给本就处于社会不利地位的患者带来了额外负担，并引发许多医学并发症。本研究旨在评估双侧下颌下腺切除术（BS）治疗ND患儿流涎在家长满意度、并发症及流涎复发方面的有效性。
患者/材料与方法：对1996年1月至2008年11月间在我科接受BS治疗的所有ND且流涎的儿童进行回顾性研究。数据取自手术记录和患者档案。家长满意度分为四类：A：75 - 100%满意（流涎不频繁，量少；无流涎）；B：50 - 75%满意（偶尔流涎，整日断断续续；流涎不频繁，量少）；C：25 - 50%满意（频繁流涎，但不大量；偶尔流涎，整日断断续续）；D：0 - 25%满意（持续流涎，总是湿的；频繁流涎，但不大量）。
85例患者接受了BS手术（男性38%；女性62%；中位年龄9岁）。35例患者因病历缺失被排除在研究之外。其余50例患者中仅有3例复发。家长满意度等级（PSG）为A的有26例（55.3%）；B的有15例（31.9%）；C的有3例（6.4%）；D的有3例（6.4%）。首次随访通常在术后1周（中位时间为2周）。术后并发症发生率为4%，且所有并发症均为轻微并发症。
讨论/结论：由于术前/术后无法精确量化流涎量，因此对所取得结果的评估是主观的。尽管如此，如低并发症发生率所示，BS是一种简单且安全的手术。它也是一种有效的手术；仅3例复发，87.2%的病例PSG为A或B，表明流涎至少改善了50%。
