Philadelphia, Pa.; Camden, N.J.; and Columbus, Ohio From the Division of Plastic Surgery, The Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania; Jefferson Medical School, Thomas Jefferson University Hospital; Cooper University Hospital; The Ohio State University College of Medicine; and the Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital.
Plast Reconstr Surg. 2013 Sep;132(3):613-622. doi: 10.1097/PRS.0b013e31829ad109.
The purpose of this study was to evaluate the long-term outcomes following modified Furlow palatoplasty over a 30-year experience at a single institution.
A retrospective review was performed of all nonsyndromic patients undergoing primary modified Furlow palatoplasty at The Children's Hospital of Philadelphia between 1980 and 2011. Surgical success was evaluated by the rate of postoperative oronasal fistula, speech outcomes assessed at a minimum of age 5 years, and the need for secondary surgery for velopharyngeal dysfunction. Results were analyzed by surgeon, Veau cleft type, age at repair, and over time.
Eight hundred sixty-nine patients who underwent modified Furlow repair were included in this study. The mean age at palatoplasty was 1.1 years, and the mean length of follow-up was 6.7 years. Repairs were performed by 11 surgeons, with 44.3 percent performed by a single surgeon. The overall oronasal fistula rate was 5.2 percent, and this improved significantly over the 30-year period (p = 0.003). Speech results at age 5 or older were available for 559 patients. Of these 559 patients, 72.4 percent had a competent velopharyngeal mechanism, and 21.5 percent had a borderline mechanism consistent with socially acceptable speech. Secondary pharyngeal surgery was indicated in 8.1 percent of patients. Speech results were stable (p = 0.10), and rates of secondary surgery for velopharyngeal dysfunction declined significantly over the study period (p = 0.005).
The authors' 30-year experience with the modified Furlow palatoplasty shows stable speech results, decreasing rates of secondary surgery, and an acceptable rate of postoperative oronasal fistula.
本研究旨在评估单中心 30 年改良 Furlow 腭裂修补术的长期效果。
对 1980 年至 2011 年期间在费城儿童医院接受初次改良 Furlow 腭裂修补术的所有非综合征患者进行回顾性研究。通过术后或鼻口腔瘘的发生率、5 岁以上的语音评估结果以及需要二次手术治疗腭咽闭合不全的发生率来评估手术效果。结果通过手术医生、Veau 裂隙类型、修复年龄和时间进行分析。
本研究共纳入 869 例接受改良 Furlow 修复的患者。腭裂修补术的平均年龄为 1.1 岁，平均随访时间为 6.7 年。由 11 名外科医生进行修复，其中 44.3%由一名外科医生完成。总的或鼻口腔瘘发生率为 5.2%，且在 30 年期间显著改善（p=0.003）。559 例患者年龄在 5 岁或以上时可获得语音结果。在这 559 例患者中，72.4%的腭咽闭合功能正常，21.5%的患者存在边界性腭咽闭合功能，符合社会可接受的语音标准。8.1%的患者需要二次咽成形术。语音结果稳定（p=0.10），且在研究期间，腭咽闭合不全的二次手术率显著下降（p=0.005）。
作者 30 年的改良 Furlow 腭裂修补术经验表明，该手术具有稳定的语音效果、降低的二次手术率和可接受的术后或鼻口腔瘘发生率。
