腭裂修复术腭咽肌肉重建与否的鼻咽内窥镜的比较观察  

Nasendoscopic comparison for cleft palate repair after velopharyngeal muscle reconstruction

作　　者：程宁新[1] 赵敏[2] 邓慧[1] 戚可名[2] 吴戴红[1] 方真[2] 宋儒耀[2] 

机构地区：[1]广州医学院附属市一人民医院整形外科,510180 [2]中国医学科学院整形外科医院

出　　处：《中华整形外科杂志》2007年第1期16-18,共3页Chinese Journal of Plastic Surgery

基　　金：广东省科委社会发展科技资助项目（2002-254-19）

摘　　要：目的通过是否进行腭咽肌肉重建的两组腭裂修复术后患者鼻咽内窥镜的比较观察，了解腭咽部肌肉重建术后腭咽闭合状况的改变。方法将41例腭裂术后患者，按照在腭裂修复时是否进行腭咽肌肉重建分为重建组（22例）和非重建组（19例），以鼻咽纤维内窥镜记录静态和发音时腭咽闭合运动状况，对两组患者腭咽闭合运动类型和状况进行比较。结果重建组静态腭咽腔形态较非重建组明显缩小，各壁光滑丰满，未见软腭鼻腔面V型缺损畸形；动态时以环状闭合为主。非重建组静态腭咽腔形态较大，可见软腭鼻腔面V型缺损畸形；动态时以冠状闭合为主。经比较重建组腭咽闭合良好率（90．91％）明显优于非重建组（37．31％）。结论鼻咽内窥镜观察证实腭咽肌肉重建腭裂修复术后腭咽闭合功能恢复明显优于非重建组。腭裂修复术时重建腭咽肌肉有助于缩小腭咽腔和更易于达到良好的腭咽闭合状态。Objective To find out the nasendoscopic changes of velopharyngeal configuration and movement after palatoplasty with or without velopharyngeal muscle reconstruction. Methods The nasendoscopy was taken in forty-one patients with palatoplasty, 22 repaired by velopharyngeal muscle reconstruction and 19 with modified yon Langenbeck＇s procedure （non-reconstructive group）. Results In patients with velopharyngeal muscle reconstruction, the velopharyngeal ports are smooth and full with a definite reduction in size than patients without veIopharyngeal muscle reconstruction. During phonation, the complete and marginal velopharyngeal competence rate in reconstructive group （90.91% ） is higher than the group of non-reconstruction （37.31% ）. The major velopharyngeal closure is circular movement in reconstructive group, otherwise coronal closure in nonconstructive group. Conclusions Based the observation of nasendoscopy, the velopharyngeal muscle reeonstraction in palatoplasty has more definite improvement to velopharyngeal closure than non-reconstructive procedure. Palatoplasty with velopharyngeal muscle reconstruction could reduce the size of velopharyngeal port and make the complete velopharyngeal closure easier.

关 键 词：腭裂修复术 腭咽闭合 肌肉重建 鼻咽内窥镜 

分 类 号：R686[医药卫生—骨科学]