Glover Chris D, Fernandez Allison M, Huang Henry, Derderian Christopher, Binstock Wendy, Reid Russell, Dalesio Nicholas M, Zhong John, Stricker Paul A
Department of Anesthesiology and Perioperative Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA.
Department of Anesthesiology, Pain and Perioperative Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
Paediatr Anaesth. 2018 Aug;28(8):710-718. doi: 10.1111/pan.13418. Epub 2018 Jun 19.
BACKGROUND/AIMS: The evolution of Le Fort III and Monobloc procedures with utilization of distraction devices has resulted in shortened surgical times, greater facial advancements, and decreased transfusion requirements. The aim of this observational study was to utilize data from the multicenter Pediatric Craniofacial Surgery Perioperative Registry to present and compare patient characteristics and outcomes in children undergoing midface advancement with distraction osteogenesis.
We queried the Pediatric Craniofacial Surgery Perioperative Registry for children undergoing midface advancement involving distractor application from June 2012 to September 2016. Data extracted included demographics, perioperative management, complications, fluid and transfusion volumes, and length of stay. The extracted patient characteristics and perioperative variables were summarized and compared.
The query yielded 72 cases from 11 institutions: 49 children undergoing Le Fort III and 23 undergoing Monobloc procedures. Monobloc patients were younger, weighed less, and more likely to have tracheostomies along with elevated intracranial pressure. Greater transfusion was observed in the Monobloc group for nearly all of the transfusion outcomes evaluated. Median ICU and hospital length of stay were 2 and 3 days longer, respectively, in the Monobloc group. Perioperative complications were not uncommon, occurring in 18% of patients in the Le Fort III group and 30% in the Monobloc group.
Monobloc procedures were associated with greater transfusion and longer ICU and hospital length of stay. Perioperative complications were more prevalent in the Monobloc group.
背景/目的：随着牵引装置的应用，Le Fort III型手术和整块手术不断发展，手术时间缩短，面部推进效果更佳，输血需求减少。本观察性研究的目的是利用多中心小儿颅面外科围手术期注册中心的数据，展示并比较接受牵张成骨术进行面中部推进的儿童的患者特征和手术结果。
我们查询了小儿颅面外科围手术期注册中心2012年6月至2016年9月期间接受涉及牵张器应用的面中部推进手术的儿童的数据。提取的数据包括人口统计学信息、围手术期管理、并发症、液体和输血量以及住院时间。对提取的患者特征和围手术期变量进行总结和比较。
查询得到来自11个机构的72例病例：49例接受Le Fort III型手术，23例接受整块手术。整块手术患者年龄更小，体重更轻，更有可能行气管切开术且颅内压升高。在几乎所有评估的输血结果中，整块手术组的输血量都更多。整块手术组的重症监护病房（ICU）和住院时间中位数分别长2天和3天。围手术期并发症并不少见，Le Fort III型手术组18%的患者发生并发症，整块手术组为30%。
整块手术与更多输血以及更长的ICU和住院时间相关。围手术期并发症在整块手术组中更为普遍。
