Furlow反向双Z法腭裂修复术后腭瘘发生率研究.docVIP

Furlow反向双Z法腭裂修复术后腭瘘发生率研究 　　[摘要]目的:研究腭裂Furlow术后瘘的发生率以及影响因素。方法:对53例腭裂修复术后瘘的发生率和可能影响瘘发生的因素如性别、年龄、腭裂类型、裂隙的程度进行回顾性研究。结果:总瘘孔率为18.86%(10/53),瘘孔率最高为硬腭前部(64%),其次为软硬腭交界处及硬腭部(分别为18%),瘘孔率最低为软腭区域(0%)(P0.05)。单侧完全性腭裂组(UCCLP,24%)和双侧完全性腭裂组(BCCLP,36.7%)瘘发生率高于硬软腭裂组(HSCP,0%)和软腭裂组(SCP,0%),但无统计学上差异(P0.05),完全性腭裂组瘘的发生率高于不完全性腭裂组(P 　　[关键词]腭裂;Furlow反向双Z腭裂修复术;瘘 　　[中图分类号]R782[文献标识码]A[文章编号]1008-6455(2010)08-1146-03 　　 　　Incidence of cleft palate fistula after Furlows double-opposing Z-palatoplasty 　　XIE Si-tian,ZHANG Wan-cong,PENG Li-hong,TANG Shi-jie 　　(Cleft Lip And Palate Treatment Center,Second Affiliated Hospital of Medical College of Shantou University Shantou 515041,Guangdong,China) 　　 　　Abstract:ObjectiveTo investigate the incidence of palatal fistula and the correlative factors influencing palatal fistula after Furlows double-opposing Z-palatoplasty.MethodsA retrospective review of 53 consecutive cleft palate cases was performed to determine the incidence of post operative fistula, and assessed possible contributing factors such as sex, age, cleft type.ResultsFistulas occurred in 10 of 53 patients(18.86% ),64% fistulas were located at the anterior hard palate . 18% fistulas at the hard palate and the junction of the hard and soft palate, and 0% in the soft palate (P0.05).The incidence in complete cleft palate was higher than that in incomplete (P 　　1.3瘘的观察:术后5～7天出院的时候检查所有患者腭部伤口愈合情况,嘱患者术后3个月回诊,若患者无复诊,予电话随访或在语音下乡复诊活动时察看伤口愈合情况。 　　1.4统计方法:采用SPSS11.0统计软件对数据进行卡方检验。 　　 　　2结果(见表1)。 　　2.1部位与腭瘘:术后出院时检查共有6例患者腭部裂开,发生在硬腭前部2例,硬软腭交界处瘘4例,并且3例在硬腭后侧臂切口粘膜瓣的尖端处口腔侧粘膜裂口,鼻腔侧粘膜尚完整。术后3月随诊,出院时4例软硬腭交界区瘘口及3例侧臂切口口腔侧粘膜裂口均自然愈合,2例硬腭前部瘘患者无愈合,另发现5例硬腭前部瘘,共7例,1例硬腭合并硬软腭交界处瘘,1例硬软腭交界处瘘,1例硬腭瘘。总瘘孔率为18.86% (10/53),瘘孔率最高为硬腭前部(64%),其次为硬软腭交界处及硬腭部(分别为18%),瘘孔率最低为软腭区域(P0.05)。 　　2.3修复时间与腭瘘:3岁前,3～6岁,6～10岁以及10岁后修复腭裂的瘘孔率之间的差异无统计学意义(P0.05)。 　　2.4腭裂类型、程度与腭瘘:BCCLP组和UCCLP组瘘发生率高于HSCP组和SCP组,但无统计学上差异(P0.05),完全性腭裂组瘘的发生率高于不完全性腭裂组(P0.05),性别也非为影响术后瘘的因素,这与石冰[6]的研究结果相符。 　　临床经验发现硬腭或软硬腭交界处裂隙宽度超过2.5cm时,术后伤口容易裂开[7]。Cohen发现腭裂