From the Section of Plastic Surgery, Department of Surgery, University of Michigan.
Plast Reconstr Surg. 2020 Dec;146(6):1340-1346. doi: 10.1097/PRS.0000000000007339.
Although most patients attain normal speech after cleft palate repair, up to 20 percent require secondary speech surgery. Despite the frequency of these procedures, complications and rates of subsequent revisions of secondary speech surgery after all procedure types have never been reviewed using national, longitudinal data.
The authors examined insurance claims from Clinformatics Data Mart between 2001 and 2017. Cases were categorized as palatalprocedures (i.e., palatoplasty, revision palatoplasty, secondary lengthening, palatal island flap) or pharyngeal procedures (i.e., pharyngeal flap, dynamic sphincter pharyngoplasty) (n = 846). Continuous enrollment from 180 days before to 30 days after surgery was required. Patients were excluded if they underwent palatoplasty, or any surgery at less than 3 years of age, without a speech diagnosis. Outcomes included 30-day complications and rates of subsequent revision secondary speech surgery. Multivariable logistic regression was used to evaluate the relationship between procedure type and complications.
In this cohort, 52.5 percent underwent pharyngeal procedures, and 47.5 percent underwent palatal procedures. Complications occurred in 10.9 percent of patients and included respiratory complications (4.0 percent), bleeding (1.2 percent), dehiscence (3.6 percent), and critical care episodes (3.0 percent). There was no difference in complications between procedure types (OR, 0.87; 95 percent CI, 0.56 to 1.37; p = 0.56). The subsequent revision rate was 12.7 percent, but was 21.7 percent in patients with 3 years of postoperative enrollment.
Although complication rates were comparable to those in recent literature, rates of subsequent revisions of secondary speech procedures were high in patients with longer postoperative enrollment. Thus, these patients merit prolonged follow-up, as velopharyngeal dysfunction may recur over time.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
尽管大多数腭裂患者在腭裂修复后能够恢复正常语音，但仍有 20%需要进行二次语音手术。尽管这些手术的频率很高，但从未使用国家纵向数据来评估所有手术类型的二次语音手术后的并发症和后续修正率。
作者检查了 2001 年至 2017 年期间 Clinformatics Data Mart 的保险索赔。病例分为腭部手术（即腭裂修复术、腭裂修复术、二次延长术、腭岛瓣术）或咽部手术（即咽成形术、动力括约肌咽成形术）（n=846）。需要满足从手术前 180 天到手术后 30 天的连续参保。如果患者接受了腭裂修复术，或在 3 岁以下接受了任何手术，且没有语音诊断，则排除在外。结果包括 30 天并发症和二次语音手术的后续修正率。多变量逻辑回归用于评估手术类型与并发症之间的关系。
在该队列中，52.5%的患者接受了咽部手术，47.5%的患者接受了腭部手术。10.9%的患者发生了并发症，包括呼吸并发症（4.0%）、出血（1.2%）、裂开（3.6%）和重症监护发作（3.0%）。不同手术类型之间的并发症发生率无差异（OR，0.87；95%CI，0.56 至 1.37；p=0.56）。二次修正率为 12.7%，但术后 3 年入组的患者为 21.7%。
尽管并发症发生率与近期文献相似，但在术后入组时间较长的患者中，二次语音手术的后续修正率较高。因此，这些患者需要延长随访，因为随着时间的推移，软腭功能障碍可能会再次发生。
临床问题/证据水平：治疗性，III 级。
