van de Velde Shirley, Smit Merel M, Logjes Robrecht J H, Martin Enrico, Haasnoot Maartje, Mink van der Molen Aebele B, Paes Emma C
Department of Pediatric Plastic and Reconstructive Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital, Lundlaan 6, 3584 EA, Utrecht, the Netherlands.
Department of Pediatric Plastic and Reconstructive Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital, Lundlaan 6, 3584 EA, Utrecht, the Netherlands.
J Craniomaxillofac Surg. 2024 Dec;52(12):1441-1448. doi: 10.1016/j.jcms.2024.08.021. Epub 2024 Aug 22.
The study aimed to: (1) compare the occurrence of postoperative respiratory difficulties (PRD) following primary cleft palate repair (CPR) in infants with an isolated cleft palate (iCP) and infants with Robin sequence (RS), and (2) describe the possible benefit of preoperative analysis with palatal plate in infants with RS. All consecutive infants with an iCP and infants with RS who underwent CPR between January 2009 and June 2022 in the Wilhelmina Children's Hospital were retrospectively reviewed. A total of 127 infants were included of which 74 infants with an iCP and 53 infants with RS. The group of infants with RS consisted of 35 infants with non-isolated RS (niRS) and 18 infants with isolated RS (iRS). Significant more PRD were seen in infants with RS compared to infants with an iCP (14/53 versus 9/74; p = 0.04). Especially infants with niRS have a significant higher risk of developing PRD in comparison with infants with an iCP (OR = 4.16, 95% CI [1.17-15.99], p = 0.031). The preoperative palatal plate screening in infants with RS (n = 25) did not show abnormalities and had no effect on the perioperative policy. Within the limitations of this study it seems that infants with niRS are more prone to develop PRD following primary CPR when compared to infants with iRS or an iCP. No clear benefit was found in postponing surgery until 12 months or later in infants with RS to avoid PRD. The preoperative palatal plate screening did not demonstrate signs of UAO in infants with RS that developed PRD. These findings suggest that preoperative analysis with palatal plate has a low predictive value.
（1）比较单纯腭裂（iCP）婴儿和患有罗宾序列征（RS）的婴儿在初次腭裂修复术（CPR）后发生术后呼吸困难（PRD）的情况，以及（2）描述对患有RS的婴儿进行术前腭板分析可能带来的益处。对2009年1月至2022年6月在威廉明娜儿童医院接受CPR的所有连续的iCP婴儿和RS婴儿进行了回顾性研究。共纳入127名婴儿，其中74名iCP婴儿和53名RS婴儿。患有RS的婴儿组包括35名非单纯RS（niRS）婴儿和18名单纯RS（iRS）婴儿。与iCP婴儿相比，RS婴儿中PRD的发生率明显更高（14/53对9/74；p = 0.04）。特别是niRS婴儿与iCP婴儿相比，发生PRD的风险显著更高（OR = 4.16，95% CI [1.17 - 15.99]，p = 0.031）。对RS婴儿（n = 25）进行的术前腭板筛查未显示异常，且对围手术期策略没有影响。在本研究的局限性内，与iRS或iCP婴儿相比，niRS婴儿在初次CPR后似乎更容易发生PRD。在患有RS的婴儿中，将手术推迟到12个月或更晚以避免PRD并没有发现明显益处。术前腭板筛查在发生PRD的RS婴儿中未显示上气道梗阻（UAO）的迹象。这些发现表明术前腭板分析的预测价值较低。
