带蒂颊脂垫瓣与碘仿纱条在腭裂松弛切口处理中的对比分析(1)
[摘要]目的：对比分析带蒂颊脂垫瓣与传统碘仿纱条在腭裂修补术中即刻充填覆盖裂隙两端松弛切口的作用和效果。方法：回顾分析2008年-2016年笔者科室诊治的148例先天性腭裂患者，随机分为带蒂颊脂垫瓣组(A组)和碘仿纱条组(B组)。其中A组采用带蒂颊脂垫瓣处理腭裂术后松弛切口，B组采用碘仿纱条处理腭裂术后松弛切口。对两组患儿术后发热、血红蛋白减少量、恶心、呕吐、松弛切口愈合时间进行对比分析。结果：B组患儿术后发热发生率明显高于A组，差异有统计学意义(P<0.05)；B组患儿手术前后血红蛋白降低值较A组偏高(P<0.05)；B组术后恶心、呕吐症状的发生率也较A组高(P<0.05)；B组愈合明显较A组慢，差异有统计学意义(P<0.05)；A、B两组术后腭瘘发生率差别无统计学意义(P>0.05)。结论：腭裂术后松弛切口采用带蒂颊脂垫瓣充填可有效降低常见术后并发症的发生，促进术区愈合。更加有利于患儿术后康复，值得临床推广应用。
[关键词]腭裂；松弛切口；带蒂颊脂垫瓣；碘仿纱条；并发症
, http://www.100md.com
[中图分类号]R783.5 [文献标志码]A [文章编号]1008-6455(2018)07-0108-04
Abstract： Objective The aim of this study was to analyze the effect of pedicled buccal fat pad flap for relaxation incision in the surgery in contrast with the filling with traditional iodoform gauze. Methods Retrospective analysis of the 148 cases of congenital cleft palate patients diagnosed and managed in our department. The sample was divided to two groups： pedicled buccal fat pad(group A) and iodoform gauze(group B). Patients in group A were treated with pedicled buccal fat pad flap for relaxation incision， and patients in group B were deal with iodoform gauze. Then， two groups of children were analyzed in postoperative fever， bleeding， nausea， vomiting， healing of relaxation wounds. Results The incidence of fever was significantly higher in group B patients than that in group A patients(P<0.05)； The decrease of hemoglobin in group B patients was higher than that in group A patients(P<0.05)； The incidence of postoperative nausea and vomiting was higher in group B patients than that in group A patients(P<0.05)； The wound healing in group B patients was significantly slower than that of group A patients(P<0.05)； The difference between group A and group B was not statistic significant(P>0.05). Conclusion Cleft palate relaxation incision filling with pedicled buccal fat pad flap can effectively reduce the incidence of common postoperative complications， promote repaired area healing. This method is more conducive to postoperative rehabilitation， and it is worth in the clinical promotion.
, http://www.100md.com
Key words： cleft palate； relaxation incision； pedicled buccal fat pad flap； iodoform gauze； complications
先天性腭裂是口腔頜外科常见病，其发生与环境、人种、社会经济条件、环境等多种因素相关，全球发病率约为1/700，中国的新生儿唇腭裂发生率约为1.42/1 000[1-2]。外科手术是修复腭裂的唯一治疗方法。手术主要是在裂隙两侧各形成一个黏骨膜瓣，黏骨膜瓣外侧再行松弛切口，使得两侧腭黏骨膜瓣向中央靠拢，以减小张力防止腭瘘的形成。对于松弛切口处裸露的骨面，为预防术后出血，食物嵌塞，有利于创面愈合等原因，局部可填塞碘仿纱条。然而在实际的临床工作中常见到一些用碘仿纱条充填的患儿术后出现发热、出血、创口愈合时间延长、恶心、呕吐等现象，且发生率较高[3]。1977年，Egyedi[4]首创将颊脂垫瓣用于修复口腔、鼻腔瘘。此后，多位学者相继对其使用范围进一步扩大。1995年，Hudson[5]第一次将颊脂垫瓣引入腭裂缺损修复中。为改善碘仿纱条填塞松弛切口所产生的并发症情况，笔者科室采用带蒂颊脂垫瓣来充填腭裂松弛切口，术后取得了良好效果。本研究就带蒂颊脂垫瓣和传统的碘仿纱条填充腭裂松弛切口患儿术后并发症和术区愈合情况进行对比分析，现报道如下。, http://www.100md.com(尹小朋 许慧芬 刘慧)
[关键词]腭裂；松弛切口；带蒂颊脂垫瓣；碘仿纱条；并发症
, http://www.100md.com
[中图分类号]R783.5 [文献标志码]A [文章编号]1008-6455(2018)07-0108-04
Abstract： Objective The aim of this study was to analyze the effect of pedicled buccal fat pad flap for relaxation incision in the surgery in contrast with the filling with traditional iodoform gauze. Methods Retrospective analysis of the 148 cases of congenital cleft palate patients diagnosed and managed in our department. The sample was divided to two groups： pedicled buccal fat pad(group A) and iodoform gauze(group B). Patients in group A were treated with pedicled buccal fat pad flap for relaxation incision， and patients in group B were deal with iodoform gauze. Then， two groups of children were analyzed in postoperative fever， bleeding， nausea， vomiting， healing of relaxation wounds. Results The incidence of fever was significantly higher in group B patients than that in group A patients(P<0.05)； The decrease of hemoglobin in group B patients was higher than that in group A patients(P<0.05)； The incidence of postoperative nausea and vomiting was higher in group B patients than that in group A patients(P<0.05)； The wound healing in group B patients was significantly slower than that of group A patients(P<0.05)； The difference between group A and group B was not statistic significant(P>0.05). Conclusion Cleft palate relaxation incision filling with pedicled buccal fat pad flap can effectively reduce the incidence of common postoperative complications， promote repaired area healing. This method is more conducive to postoperative rehabilitation， and it is worth in the clinical promotion.
, http://www.100md.com
Key words： cleft palate； relaxation incision； pedicled buccal fat pad flap； iodoform gauze； complications
先天性腭裂是口腔頜外科常见病，其发生与环境、人种、社会经济条件、环境等多种因素相关，全球发病率约为1/700，中国的新生儿唇腭裂发生率约为1.42/1 000[1-2]。外科手术是修复腭裂的唯一治疗方法。手术主要是在裂隙两侧各形成一个黏骨膜瓣，黏骨膜瓣外侧再行松弛切口，使得两侧腭黏骨膜瓣向中央靠拢，以减小张力防止腭瘘的形成。对于松弛切口处裸露的骨面，为预防术后出血，食物嵌塞，有利于创面愈合等原因，局部可填塞碘仿纱条。然而在实际的临床工作中常见到一些用碘仿纱条充填的患儿术后出现发热、出血、创口愈合时间延长、恶心、呕吐等现象，且发生率较高[3]。1977年，Egyedi[4]首创将颊脂垫瓣用于修复口腔、鼻腔瘘。此后，多位学者相继对其使用范围进一步扩大。1995年，Hudson[5]第一次将颊脂垫瓣引入腭裂缺损修复中。为改善碘仿纱条填塞松弛切口所产生的并发症情况，笔者科室采用带蒂颊脂垫瓣来充填腭裂松弛切口，术后取得了良好效果。本研究就带蒂颊脂垫瓣和传统的碘仿纱条填充腭裂松弛切口患儿术后并发症和术区愈合情况进行对比分析，现报道如下。, http://www.100md.com(尹小朋 许慧芬 刘慧)
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