Susarla Srinivas M, Mundinger Gerhard S, Chang Christopher C, Swanson Edward W, Lough Denver, Rottgers S Alex, Redett Richard J, Kumar Anand R
Baltimore, Md.
From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital.
Plast Reconstr Surg. 2017 Jan;139(1):149-154. doi: 10.1097/PRS.0000000000002865.
This study was conducted to compare the gastrostomy rates in infants with Pierre Robin sequence treated with tongue-lip adhesion or mandibular distraction osteogenesis.
This was a retrospective study of symptomatic plastic and reconstructive surgery patients treated over an 8-year period. The primary predictor variable was surgical intervention (tongue-lip adhesion or distraction osteogenesis). Secondary predictor variables were categorized as demographic and clinical factors. The primary outcome was the need for gastrostomy tube placement. Secondary outcomes were complication rates, costs, and length of stay.
Thirty-one tongue-lip adhesion and 30 distraction osteogenesis patients were included in the study. The groups were statistically comparable with regard to demographic and clinical factors (p > 0.18). Gastrostomy rates were higher in patients who underwent tongue-lip adhesion (48 percent) versus those who underwent distraction osteogenesis (16.7 percent; p = 0.008). In an adjusted model, subjects undergoing tongue-lip adhesion were more likely to require gastrostomy tube for nutritional support (OR, 6.5; 95 percent CI, 1.7 to 25.2; p = 0.007). There were two major complications in the tongue-lip adhesion group and none in the distraction osteogenesis group. There were three minor complications in the tongue-lip adhesion group and five in the distraction osteogenesis group. Total operating room costs were higher for distraction osteogenesis (p = 0.05), and total hospital costs and length of stay were higher for tongue-lip adhesion (p < 0.05).
Among infants with symptomatic Pierre Robin sequence, treatment by distraction osteogenesis is associated with a lower risk for gastrostomy placement for nutritional support. Hospital costs are higher for tongue-lip adhesion.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
本研究旨在比较接受舌唇粘连术或下颌骨牵张成骨术治疗的罗宾序列征患儿的胃造口率。
这是一项对8年间接受有症状的整形和重建手术患者的回顾性研究。主要预测变量为手术干预（舌唇粘连术或牵张成骨术）。次要预测变量分为人口统计学和临床因素。主要结局为是否需要放置胃造口管。次要结局为并发症发生率、费用和住院时间。
本研究纳入了31例接受舌唇粘连术的患者和30例接受牵张成骨术的患者。两组在人口统计学和临床因素方面具有统计学可比性（p>0.18）。接受舌唇粘连术的患者胃造口率（48%）高于接受牵张成骨术的患者（16.7%；p=0.008）。在调整模型中，接受舌唇粘连术的患者更有可能需要胃造口管进行营养支持（OR，6.5；95%CI，1.7至25.2；p=0.007）。舌唇粘连术组有2例主要并发症，牵张成骨术组无主要并发症。舌唇粘连术组有3例次要并发症，牵张成骨术组有5例次要并发症。牵张成骨术的总手术室费用更高（p=0.05），舌唇粘连术的总住院费用和住院时间更长（p<0.05）。
在有症状性罗宾序列征的婴儿中,牵张成骨术治疗与营养支持性胃造口术的较低风险相关。舌唇粘连术的住院费用更高。
临床问题/证据级别：治疗性，III级。
