西藏高原地区唇腭裂畸形修复经验总结  

Experience of repairing cleft lip and palate deformity in Tibet

作　　者：王成龙 巴罗[2] 旦增念扎[3] 廖志鹏 次德吉[2] 尼玛吉宗[2] 索朗旺姆 王克明 Wang Chenglong;Ba Luo;Danzeng Nianza;Liao Zhipeng;Ci Deji;Nima Jizong;Suolang Wangmu;Wang Keming(Department of Ear Reconstruction,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China;Department of Otolaryngology,Tibet Autonomous Region People’s Hospital,Lhasa 850001,China;Department of Stomatology,Tibet Autonomous Region People’s Hospital,Lhasa 850001,China;Department of Head and Neck Cosmetic Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院外耳整形再造二科,北京100144 [2]西藏自治区人民医院耳鼻喉科,拉萨850001 [3]西藏自治区人民医院口腔科,拉萨850001 [4]中国医学科学院北京协和医学院整形外科医院面颈整形二科,北京100144

出　　处：《中华整形外科杂志》2023年第1期54-59,共6页Chinese Journal of Plastic Surgery

基　　金：中国医学科学院"中央级公益性科研院所基本科研业务费"(2020-RW310-005)。

摘　　要：目的:总结西藏高原地区唇腭裂畸形的特点和修复经验。方法:回顾性分析2020年8月至2021年8月援藏期间所治疗的唇腭裂畸形患者的临床资料。术前参考美国麻醉医师协会(ASA)分级对患者进行麻醉风险评估,主要采用MillardⅡ式结合唇鼻肌肉张力系统构建术对唇裂畸形进行修复,采用改良Von Langenbeck法对腭裂畸形进行修复。统计患者术中出血量,以及术后短期并发症,如血肿、感染、伤口裂开、皮瓣血运障碍、腭瘘等发生情况。术后进行随访,由患者根据Likert 5分量表对手术效果进行评分(1~5分),1分为非常不满意,5分为非常满意。通过听音评价方法对腭裂语音进行评分,满分为5分,最低分为1分。应用SPSS 22.0进行统计分析,计量资料以±s表示,手术前、后腭裂语音评分采用配对t检验进行比较,P<0.05为差异有统计学意义。结果:共纳入46例患者,男26例,女20例,年龄2~57岁,中位数为32岁。46例中唇裂及唇裂术后继发畸形患者36例,其中28例为初次修复,8例为继发畸形的修复;腭裂畸形10例,均为初次修复手术。46例中ASAⅠ级39例,ASAⅡ级5例,ASAⅢ级2例。合并有先天性心脏病患者5例,其中动脉导管未闭2例,卵圆孔未闭3例;合并肺动脉高压8例。唇裂和腭裂畸形术中平均出血量分别为30 ml和50 ml,术后未发生上述并发症。术后随访6~24周,平均8周,唇裂畸形修复患者患侧唇峰下降充分,与健侧基本对称,双侧鼻孔对称性较术前明显改善,鼻小柱居中;腭裂患者裂隙封闭,软腭活动度改善。患者对手术效果均较为满意,满意度评分平均为4.5分。腭裂术后语音评分为(4.3±0.5)分,明显高于术前的(1.4±0.5)分(t=16.16,P<0.001)。结论:西藏地区唇腭裂畸形患者具有治疗时机延误、畸形程度复杂、多合并其他器官先天性畸形等特点,术前要仔细评估患者全麻风险,采用经典术式对唇腭裂进行修复,可获得较好的效果和Objective To summarize the repair experience and clinical characteristics of cleft lip and palate in Tibet.Methods From August 2020 to August 2021,patients with cleft lip and palate treated during the period of corresponding author aid to Tibet were included.The American Association of Anesthesiologists(ASA)was used to assess the anesthesia risk before operation.For the cleft lip repair,Millard rotation advancement technique and reconstruction of nasal-labial muscle tension lines group were used.Modified Von Langenbeck technique was adopted for cleft palate repair.The amount of blood loss and short-term postoperative complications such as hematoma,infection,wound dehiscence,flap circulation disorder and palatal fistula were counted.The Likert five-point scale was used to evaluate the surgical satisfaction of patients with cleft lip and the audiometric evaluation method was used to assess the improvement of cleft palate speech.The data were statistically analyzed by SPSS 20.0 software.The measurement data were expressed by Mean±SD.P<0.05 was considered statistically significant.Results A total of 46 patients were included,including 26 males and 20 females,aged from 2 to 57 years,with a median of 32 years.There were 36 patients with cleft lip or secondary deformities after cleft lip surgery and 10 patients with cleft palate.Among the 46 cases,ASAⅠwas 39,and ASAⅡ,ASAⅢwere 5 and 2,respectively.There were 5 patients with congenital heart disease,including 2 cases of patent ductus arteriosus and 3 cases of patent foramen ovale.Pulmonary hypertension was found in 8 cases.The average blood loss during the repair of cleft lip and cleft palate was 30 ml and 50 ml,respectively.No postoperative complications such as hematoma,infection,wound dehiscence and palatal fistula occurred.The patients were followed up for 6 to 24 weeks,with an average of 8 weeks.The crista philtra point on the affected side of the patients with cleft lip was fully lowered and was basically symmetrical with the healthy side.The bilateral nostri

关 键 词：唇裂 腭裂 西藏高原 修复外科手术 

分 类 号：R782.2[医药卫生—口腔医学]