Boston, Mass. From the Departments of Plastic and Oral Surgery and Anesthesiology, Children's Hospital Boston and Harvard Medical School.
Plast Reconstr Surg. 2011 Jul;128(1):243-251. doi: 10.1097/PRS.0b013e318217420d.
The compromised airway in Robin sequence demands prompt operative intervention. Tongue-lip adhesion is one alternative; however, the outcome of this technique is variable. The purpose of this study was to identify variables that preoperatively predict the success of adhesion in Robin sequence patients with life-threatening respiratory distress.
This is a retrospective review of infants with severe (Laberge grade II or III) Robin sequence managed by tongue-lip adhesion. Variables analyzed included diagnosis (syndromic versus nonsyndromic), age at operation, preoperative and postoperative airway management, duration of intubation, length of intensive care and hospital stay, serial weight, and postoperative complications.
Fifty-three infants had tongue-lip adhesion for airway compromise: 47 (89 percent) were successfully managed and treatment failed in six. Preoperative intubation, days of intubation, intensive care unit days and hospitalization, and reintubation were more common in syndromic infants (p < 0.05). Those infants who had adhesion within 14 days of birth required shorter duration of postoperative ventilator support and intensive care unit/hospital stay (p < 0.05) than those who had a later procedure. Significant variables were gastroesophageal reflux (p = 0.002), intubation preoperatively (p = 0.002), late operation (older than 2 weeks) (p = 0.001), low birth weight (<2500 g) (p = 0.01), and syndromic diagnosis (p < 0.001). The acronym GILLS summarizes these predictive findings; one point was assigned for each variable present. Adhesion was successful in 100 percent of infants with a GILLS score of 2 or less (n = 39) but failed in 43 percent (six of 14 infants) with a score of 3 or more.
The GILLS score may improve patient selection and predict outcome of tongue-lip adhesion in infants with Robin sequence.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.(Figure is included in full-text article.).
Robin 序列中气道受损需要及时进行手术干预。舌唇粘连是一种选择，但其效果存在差异。本研究旨在确定术前预测具有生命威胁性呼吸窘迫的 Robin 序列患者粘连成功的变量。
这是一项对严重（Laberge 分级 II 或 III）Robin 序列并通过舌唇粘连进行气道管理的婴儿的回顾性研究。分析的变量包括诊断（综合征与非综合征）、手术年龄、术前和术后气道管理、插管时间、重症监护和住院时间、体重序列以及术后并发症。
53 例婴儿因气道阻塞行舌唇粘连术：47 例（89%）成功，6 例治疗失败。综合征患儿术前插管、插管天数、重症监护天数和住院天数以及再次插管更为常见（p < 0.05）。出生后 14 天内进行粘连的婴儿需要较短的术后呼吸机支持和重症监护/住院时间（p < 0.05），而那些手术较晚的婴儿则需要更长的时间。显著的变量包括胃食管反流（p = 0.002）、术前插管（p = 0.002）、晚期手术（2 周后）（p = 0.001）、低出生体重（<2500 g）（p = 0.01）和综合征诊断（p < 0.001）。缩写 GILLS 总结了这些预测发现；每个存在的变量分配 1 分。GILLS 评分为 2 或更低的婴儿中，粘连成功率为 100%（n = 39），而评分为 3 或更高的婴儿中，粘连成功率为 43%（14 例中有 6 例）。
GILLS 评分可改善患者选择，并预测 Robin 序列婴儿舌唇粘连的结果。
临床问题/证据水平：风险，II.（图包含在全文中。）
