Zhao Shufan, Xu Yi, Yin Heng, Zheng Qian, Wang Yan, Zhong Tianhang, Li Yang, Shi Bing
Department of Cleft Lip and Palate Surgery, West China College of Stomatology, Sichuan University, Chengdu, Sichuan Province, China.
J Craniofac Surg. 2012 Nov;23(6):1602-6. doi: 10.1097/SCS.0b013e3182564910.
This was a study of patients with cleft palate who for various reasons have their first hospital visit for palatal repair at an older age in developing countries. The aims of this study were to investigate the incidence of postoperative velopharyngeal insufficiency in Chinese patients with late palatal repair and to determine the relative importance of age at palatoplasty, cleft type, surgical technique, and experience for clinical outcomes.
A cohort of 224 patients who underwent primary palate repair were studied retrospectively. Speech outcomes were evaluated based on the severity of hypernasality and nasal emission. The percentage of cases that required a second operation was recorded. The related factors were analyzed, and a logistic regression model was applied.
The mean age at palatoplasty was 5.6 (SD, 4.6) years (age range, 2-24 years of age); 29.9% of the cases required a second operation. Age at palatoplasty was the only significant contributing factor for the percentage of patients who needed a second surgery. Each additional year in age at palatoplasty was associated with a 10.8% increase in odds of requiring a second surgery (P = 0.002; odds ratio, 1.108; confidence interval, 1.038-1.182). However, cleft type, surgical technique, and surgeon's experience did not influence clinical outcomes.
Primary palate repair at older than 2 years resulted in acceptable clinical speech outcomes in our patient population, there was an increase in the incidence of postoperative velopharyngeal insufficiency with increasing age at the time of palatoplasty. There was no correlation with cleft type, surgical technique, or surgeon's experience.
本研究针对发展中国家因各种原因首次因腭裂修复而在较大年龄就诊的患者。本研究的目的是调查中国腭裂修复较晚患者术后腭咽闭合不全的发生率，并确定腭裂修复年龄、腭裂类型、手术技术和经验对临床结果的相对重要性。
对224例接受一期腭裂修复的患者进行回顾性研究。根据鼻音过重和鼻漏气的严重程度评估语音结果。记录需要二次手术的病例百分比。分析相关因素，并应用逻辑回归模型。
腭裂修复的平均年龄为5.6（标准差，4.6）岁（年龄范围，2至24岁）；29.9%的病例需要二次手术。腭裂修复年龄是需要二次手术患者百分比的唯一显著影响因素。腭裂修复年龄每增加一岁，需要二次手术的几率增加10.8%（P = 0.002；优势比，1.108；置信区间，1.038 - 1.182）。然而，腭裂类型、手术技术和外科医生的经验并未影响临床结果。
在我们的患者群体中，2岁以后进行一期腭裂修复可获得可接受的临床语音结果，随着腭裂修复年龄的增加，术后腭咽闭合不全的发生率增加。与腭裂类型、手术技术或外科医生的经验无关。
