Zhang Bei, Yang Chao, Yin Heng, Pang Yuya, Shi Bing, Zheng Qian, Cheng Xu
State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, 14 Ren Min Nan Road, Chengdu, 610041, PR China.
State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, 14 Ren Min Nan Road, Chengdu, 610041, PR China.
J Craniomaxillofac Surg. 2022 Sep;50(9):705-711. doi: 10.1016/j.jcms.2022.07.004. Epub 2022 Aug 3.
This study aimed to find a surgical treatment algorithm for secondary velopharyngeal insufficiency (VPI), with Furlow palatoplasty or posterior pharyngeal flap (PPF), balancing speaking and breathing. Non-syndromic cleft palate patients with secondary VPI who underwent Furlow palatoplasty or PPF were reviewed. A multinomial logistic regression model was employed to estimate the association between preoperative variables and surgical outcomes. A series of multinomial logistic regression models was utilized to determine the cut-off value of the significant predictors for subgroup comparison. In total, 203 patients were enrolled, with 73 receiving Furlow palatoplasty and 130 receiving PPF. The surgical outcomes of the two techniques were significantly different (p = 0.005). Age was a significant predictor in all intragroup comparative analyses. Preoperative VCR was associated with postoperative velopharyngeal function in patients undergoing Furlow palatoplasty (p = 0.042). The best cut-off values were an age of 13 years and a VCR of 70%. Surgical outcomes in both group B (age <13, VCR <70%; p = 0.017) and group C (age ≥13, VCR ≥70%; p = 0.003) differed significantly between the two surgical techniques. Within the limitations of the study, it is seems that in patients aging <13 years and with a VCR of ≥70%, Furlow palatoplasty should be preferred whenever appropriate to receive adequate velopharyngeal function.
本研究旨在寻找一种针对继发性腭咽闭合不全（VPI）的外科治疗方案，采用Furlow腭成形术或咽后壁瓣（PPF），平衡言语和呼吸功能。对接受Furlow腭成形术或PPF的非综合征性腭裂继发VPI患者进行了回顾性研究。采用多项逻辑回归模型评估术前变量与手术结果之间的关联。利用一系列多项逻辑回归模型确定亚组比较中显著预测因素的临界值。总共纳入了203例患者，其中73例接受了Furlow腭成形术，130例接受了PPF。两种技术的手术结果有显著差异（p = 0.005）。在所有组内比较分析中，年龄是一个显著的预测因素。术前VCR与接受Furlow腭成形术患者的术后腭咽功能相关（p = 0.042）。最佳临界值为年龄13岁和VCR 70%。B组（年龄<13岁，VCR<70%；p = 0.017）和C组（年龄≥13岁，VCR≥70%；p = 0.003）两种手术技术的手术结果均有显著差异。在本研究的局限性内，似乎对于年龄<13岁且VCR≥70%的患者，在适当情况下应优先选择Furlow腭成形术以获得足够的腭咽功能。
