腭裂 61 例早期和晚期行咽成形术的适应证。
Criteria for early and late velopharyngoplasty in 61 children with cleft palate.
机构信息
Department of Maxillo-facial and Plastic Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; facial cleft and malformation national network, Paris, France.
Department of Maxillo-facial and Plastic Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; facial cleft and malformation national network, Paris, France; University of Paris, France.
出版信息
J Stomatol Oral Maxillofac Surg. 2022 Oct;123(5):e521-e525. doi: 10.1016/j.jormas.2022.03.003. Epub 2022 Mar 8.
BACKGROUND
Velopharyngeal insufficiency persists in 15 to 30% of children with cleft palate, despite early velar surgery. Pharyngoplasty using a superior pedicle flap is the most common secondary surgery to treat velopharyngeal insufficiency. This study aims to identify the criteria leading to indicate velopharyngoplasty in 3 groups of age.
MATERIALS AND METHODS
we conducted a retrospective single center study in the reference center for cleft palate in Paris from 2013 to 2016. We included 61 children with non-syndromic cleft operated on with a velopharyngoplasty for velopharyngeal insufficiency. Pre-operative speech and surgical assessments, as well as the operative reports of the children, were analyzed retrospectively using multivariate models.
RESULTS
We included 61 patients. The only criteria factor for an early velopharyngoplasty was the Pittsburgh Weighted Speech Scale (PWSS) score (OR 1.20, CI 95% 1.07 to 1.4 ; P=.006). Criteria for a late velopharyngoplasty were a degradation of the velopharyngeal function (OR 16.07, CI 95% 1.7 to 518.7 ; P=.041) and lost of follow-up (OR 5.78, CI 95% 3.9 to 4320 ; P=.017).
CONCLUSION
Criteria for early and late velopharyngoplasty were identified, and we demonstrated the insufficiency of Borel-Maisonny classification for scientific clinical study.
背景
尽管早期行软腭裂手术，但仍有 15%至 30%的腭裂患儿存在腭咽闭合不全。应用带蒂上方皮瓣的咽成形术是治疗腭咽闭合不全的最常见的二次手术。本研究旨在确定 3 组年龄患者行腭咽成形术的指征。
材料和方法
我们在巴黎腭裂参考中心进行了一项回顾性单中心研究，时间为 2013 年至 2016 年。我们纳入了 61 例非综合征性腭裂患儿，这些患儿因腭咽闭合不全而行腭咽成形术。采用多变量模型对患儿的术前语音和手术评估以及手术报告进行回顾性分析。
结果
我们纳入了 61 例患者。早期行腭咽成形术的唯一指征是匹兹堡语音可懂度分级（PWSS）评分（OR 1.20，95%CI 1.07 至 1.4；P=.006）。行晚期腭咽成形术的指征是腭咽功能恶化（OR 16.07，95%CI 1.7 至 518.7；P=.041）和失访（OR 5.78，95%CI 3.9 至 4320；P=.017）。
结论
确定了早期和晚期腭咽成形术的指征，并证明 Borel-Maisonny 分类法对于科学临床研究的不足。
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