多次手术对青少年唇腭裂患者社会心理功能的长期影响。
Long-Term Effect of Multiple Operations on Psychosocial Function in Teenage Cleft Lip and Palate Patients.
机构信息
From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine; the Institute for Digital Research and Education, Department of Statistics, University of California, Los Angeles; and the Cleft Palate Program, Orthopaedic Institute for Children.
出版信息
Plast Reconstr Surg. 2020 Jul;146(1):61e-68e. doi: 10.1097/PRS.0000000000006905.
BACKGROUND
Cleft lip and palate patients undergo a significant number of interventions during their childhood and adolescence. Although the intention of such interventions is to improve psychosocial functioning, there exists a paucity of data on the psychosocial outcomes of the burden of care on cleft children. In this work, the long-term effects of quantity and timing of childhood operations on teenagers with cleft lip and palate were evaluated.
METHODS
Cleft lip and palate patients (aged 14 to 17 years; n = 55) and an age-matched unaffected cohort (n = 14) prospectively enrolled from two institutions were administered the anger, anxiety, and depressive symptoms instruments from the Pediatric Patient-Reported Outcomes Measurement Information System. Total number of operations and operations stratified by age groups (0 to 7, 8 to 10, 11 to 13, and 14 to 17 years) were evaluated in relationship to instrument scores. Descriptive statistics, independent t tests, Pearson correlations, and multiple linear regression analyses were conducted.
RESULTS
No differences in overall psychosocial functioning were found between the cleft lip and palate and comparison groups. Total quantity of childhood operations did not correlate to psychosocial functioning of cleft lip and palate teenagers. However, multiple linear regression analyses demonstrated that increased number of operations in the 8- to 10-year-old age range predicted increased anxiety and depressive symptoms in teenagers (β = 0.38, p = 0.009; and β = 0.29, p = 0.03, respectively).
CONCLUSIONS
It was previously reported by the authors' group that the 8- to 10-year-old age range is an at-risk period for psychosocial distress in children with craniofacial anomalies. Their current work demonstrates that increased number of operations during this time frame may result in long-term consequences in anxiety and depression in cleft lip and palate patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
背景
唇腭裂患者在儿童和青少年时期会经历大量的干预措施。尽管这些干预措施的目的是改善社会心理功能，但关于照顾负担对唇腭裂儿童的社会心理结果的数据却很少。在这项工作中，评估了唇腭裂青少年童年手术数量和时间对其的长期影响。
方法
从两个机构前瞻性招募唇裂和腭裂患者（14 至 17 岁；n = 55）和年龄匹配的未受影响队列（n = 14），并使用儿科患者报告的结局测量信息系统中的愤怒、焦虑和抑郁症状量表进行评估。总手术次数和按年龄组（0 至 7、8 至 10、11 至 13 和 14 至 17 岁）分层的手术数量与量表评分的关系进行评估。采用描述性统计、独立 t 检验、皮尔逊相关和多元线性回归分析。
结果
唇腭裂和对照组之间的总体社会心理功能无差异。童年手术总量与唇腭裂青少年的社会心理功能无关。然而，多元线性回归分析表明，8 至 10 岁年龄段手术次数的增加预测了青少年焦虑和抑郁症状的增加（β=0.38，p=0.009；β=0.29，p=0.03）。
结论
作者小组之前曾报道，8 至 10 岁是颅面畸形儿童出现社会心理困扰的高危期。他们目前的工作表明，在此期间增加手术次数可能会对唇腭裂患者的焦虑和抑郁产生长期影响。
临床问题/证据水平：风险，II 级。
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