提肌重建联合Z成形及颊粘膜瓣转移术在幼儿腭裂.doc

提肌重建联合“Z”成形及颊粘膜瓣转移术在幼儿腭裂修复中的初步应用 柯昌能 郭小宝 唐世杰 朱镇森 （汕头大学医学院第二附属医院唇腭裂中心暨整形烧伤科 汕头 515041） 《中国美容医学》2009年18卷4期 【摘要】目的 探讨提肌重建联合“Z”成形及颊粘膜瓣转移术在幼儿腭裂修复中的应用效果。方法 观察5例年龄2~3岁的完全性腭裂患儿应用提肌重建联合“Z”成形及颊粘膜瓣转移修复腭裂后的近期效果，比较术前、术后软腭的长度，观察伤口的愈合情况。结果 松弛切口骨面无过多裸露的情况下，软腭较术前延长1cm以上，松弛切口6天内基本愈合，无腭漏出现。结论 提肌重建联合“Z”成形及颊粘膜瓣转移术不但避免了松弛切口骨面的过多裸露，而且充分延长了软腭，加快了松弛切口愈合，在幼儿腭裂修复中有一定的应用价值。 【关键词】 腭裂 手术治疗 腭帆提肌 Primary application of velator muscle reconstruction combined with the Z plasty and buccal mucosal flap in child patients with cleft palate KE Chang-neng GUO Xiao-bao TANG Shi-jie ZHU Zhen-sen Centre of the cleft lip and palate ＆ burn and plastic unit, the second affiliated hospital of the medical school of Santou University. [Abstract] Object To Observe the effect of primary application of velator muscle reconstruction combined with the Z plasty and buccal mucosal flap in child patients with cleft palate. Method Velator muscle reconstruction combined with the Z plasty and buccal mucosal flap was applied to five child patients with cleft palate; the length of soft palate was messured before and after operation; wound healing was observed. Result Without much exposure of palate bone surface,the length of soft palate was extended more 1 cm than that before operation;relaxation incision healed within six days; wound disruption did not happen in all patients. Conclusion This operation style could avoid much exposure of palate bone surface,and at the same time get soft palate extention and make wound heal fast. Keyword cleft palate; operational treatment; velator muscle reconstruction 恢复腭部的正常解剖形态，改善软腭的生理功能，同时不因为手术操作而显著地影响面中份的发育一直是临床手术治疗腭裂所关注的问题。腭帆提肌吊带重建术是临床治疗腭裂的主要手术方式之一；但手术过程中粘骨膜瓣的后推缝合而延长软腭致使前腭骨面裸露较多，对婴幼儿面中份的正常发育带来了隐患。为此，我们设计了提肌重建联合“Z”成形及颊粘膜瓣转移的手术方式修复幼儿腭裂，既实现了提肌吊带重建，软腭的延长，又避免了前腭骨面过多的裸露，兹介绍如下。 对象与方法 1.1研究对象：5例2008-10至2008-12重生行动资助的在我中心治疗的腭裂患儿，年龄2~3岁，平均年龄2.6岁；男性3例，女性2例；双侧完全性腭裂2例，单侧完全性腭裂3例。 1.2 方法 1.2.1软腭长度的测量 用甲紫液在两侧上颌结节的内侧下缘标志一水平线，测量悬雍垂尖端致水平线的垂直距离，分别由术者、第一、第二助手各测量一次，取其平均值。术前两侧悬雍垂不等长者，以悬雍垂尖端至水平线