Sommerlad腭帆提肌重建术联合腭咽肌瓣咽成形术修复大龄患者腭裂的临床研究(1)
[摘要]目的：探讨Sommerlad腭帆提肌重建术联合腭咽肌瓣咽成形术修复大龄患者腭裂的临床疗效，并观察术后对腭咽功能及语音效果的影响。方法：选择2013年5月-2017年8月在口腔颌面外科就诊的58例大龄腭裂患者为研究对象。实验组：31例，男18例，女13例，年龄(15.3±6.4)岁，均在全麻下行Sommerlad腭帆提肌重建联合腭咽肌瓣咽成形术修复；对照组：27例，其中男16例，女11例，年龄(17.7±7.5)岁，全麻下行Sommerlad腭帆提肌重建术修复。术后随诊6～36个月，采用头颅侧位X线片及鼻咽纤维镜检测腭咽功能，主观语音评估鼻腔共鸣、鼻漏气、语音清晰度。结果：所有患者创口愈合良好，实验组20例获得腭咽闭合，腭咽闭合率61.3%；对照组7例获得腭咽闭合，腭咽闭合率24.4%，两者之间比较有统计学差异(P<0.05)。实验组鼻腔共鸣、鼻漏气、语音清晰度症状改善程度优于对照组(P<0.05)。结论：Sommerlad腭帆提肌重建术联合腭咽肌瓣咽成形术同期修复大龄腭裂可提高术后的腭咽功能，改善语音效果。
[关键词] 腭裂；Sommerlad腭帆提肌重建术；腭咽肌瓣咽成形术；腭咽闭合；语音清晰度
, http://www.100md.com
[中图分类号]R782.2+2 [文献标志码]A [文章编号]1008-6455(2018)09-0080-04
Clinical Study on Sommerlad Palatoplasty Combined with Sphincter Pharyngoplasty in Surgical Repair of Older Patients with Cleft Palate
CHENG Xiao-xuan， LU Yong， CAO Jun
(Department of Oral and Maxillofacial Surgery， the Affiliated Stomatology Hospital， Medicial College of Nanjing University， Nanjing 210008，Jiangsu，China)
, 百拇医药
Abstract： Objective The aim of this study was to evaluate velopharyngeal function and speech outcomes of Sommerlad palatoplasty combined with sphincter pharyngoplasty in surgical repair of older patients with cleft palate. Methods 58 patients with cleft palate were managed between May 2013 and August 2017. 31 of them were treated with Sommerlad palatoplasty(S) combined with sphincter pharyngoplasty(SP) . Their ages ranged from 8.9 to 21.7 years (mean， 15.3 years). 18 of them are male and 13 are female. In control group， 27 patients were treated with Sommerlad palatoplasty. Patients’ ages ranged from 10.2 to 25.2 years (mean， 17.7 years). 16 of them are male and 11 are female. Evaluation of velopharyngeal function was conducted by means of cephalometric analyses， nasoendoscopy. Nasal resonance， nasal leakage， speech intelligibility were assessed by an experienced speech pathologist. Results The success rate of velopharyngeal competence was 61.3 % in S+SP group and 24.4 % in S group after surgical treatment(P<0.05). There were statistic differences of nasal resonance，nasal leakage，speech intelligibility between the 2 groups(P<0.05). Conclusion It has been suggested that the surgical approach with Sommerlad palatoplasty combined with sphincter pharyngoplasty has a high rate of success in surgical repair of older patients with cleft palate.
, http://www.100md.com
Key words： cleft palate； sommerlad palatoplasty； sphincter pharyngoplasty； velopharyngeal competence； speech intelligibility
腭裂手術的最主要目的是实现腭咽闭合(Velopharyngeal Competence，VPC)，为获得正常的语音效果创造条件。在我国，由于经济状况、唇腭裂序列治疗发展不完善等诸多因素的影响，不少腭裂患者就诊时已经错过了公认的手术修复治疗的最佳时机(10～12个月)，其中大龄未手术的腭裂患者(5岁以上儿童及成人)非常多见[1-2]。西方国家由于唇腭裂序列治疗较为完善，腭裂手术基本在适龄完成，大龄腭裂手术修复的相关研究较少，无相关的治疗策略供大家参考借鉴。目前，大多数学者认为大龄腭裂患者如采用传统的幼儿一期腭裂手术方法修复往往无法达到正常发音所需的腭咽闭合功能。因此，如何选择有效而适宜的外科治疗方案，为大龄腭裂患者的语音康复奠定良好的结构基础，尽量避免多次手术创伤，是唇腭裂外科医生们努力的方向[1]。, 百拇医药(陈晓璇 鲁勇 曹俊)
[关键词] 腭裂；Sommerlad腭帆提肌重建术；腭咽肌瓣咽成形术；腭咽闭合；语音清晰度
, http://www.100md.com
[中图分类号]R782.2+2 [文献标志码]A [文章编号]1008-6455(2018)09-0080-04
Clinical Study on Sommerlad Palatoplasty Combined with Sphincter Pharyngoplasty in Surgical Repair of Older Patients with Cleft Palate
CHENG Xiao-xuan， LU Yong， CAO Jun
(Department of Oral and Maxillofacial Surgery， the Affiliated Stomatology Hospital， Medicial College of Nanjing University， Nanjing 210008，Jiangsu，China)
, 百拇医药
Abstract： Objective The aim of this study was to evaluate velopharyngeal function and speech outcomes of Sommerlad palatoplasty combined with sphincter pharyngoplasty in surgical repair of older patients with cleft palate. Methods 58 patients with cleft palate were managed between May 2013 and August 2017. 31 of them were treated with Sommerlad palatoplasty(S) combined with sphincter pharyngoplasty(SP) . Their ages ranged from 8.9 to 21.7 years (mean， 15.3 years). 18 of them are male and 13 are female. In control group， 27 patients were treated with Sommerlad palatoplasty. Patients’ ages ranged from 10.2 to 25.2 years (mean， 17.7 years). 16 of them are male and 11 are female. Evaluation of velopharyngeal function was conducted by means of cephalometric analyses， nasoendoscopy. Nasal resonance， nasal leakage， speech intelligibility were assessed by an experienced speech pathologist. Results The success rate of velopharyngeal competence was 61.3 % in S+SP group and 24.4 % in S group after surgical treatment(P<0.05). There were statistic differences of nasal resonance，nasal leakage，speech intelligibility between the 2 groups(P<0.05). Conclusion It has been suggested that the surgical approach with Sommerlad palatoplasty combined with sphincter pharyngoplasty has a high rate of success in surgical repair of older patients with cleft palate.
, http://www.100md.com
Key words： cleft palate； sommerlad palatoplasty； sphincter pharyngoplasty； velopharyngeal competence； speech intelligibility
腭裂手術的最主要目的是实现腭咽闭合(Velopharyngeal Competence，VPC)，为获得正常的语音效果创造条件。在我国，由于经济状况、唇腭裂序列治疗发展不完善等诸多因素的影响，不少腭裂患者就诊时已经错过了公认的手术修复治疗的最佳时机(10～12个月)，其中大龄未手术的腭裂患者(5岁以上儿童及成人)非常多见[1-2]。西方国家由于唇腭裂序列治疗较为完善，腭裂手术基本在适龄完成，大龄腭裂手术修复的相关研究较少，无相关的治疗策略供大家参考借鉴。目前，大多数学者认为大龄腭裂患者如采用传统的幼儿一期腭裂手术方法修复往往无法达到正常发音所需的腭咽闭合功能。因此，如何选择有效而适宜的外科治疗方案，为大龄腭裂患者的语音康复奠定良好的结构基础，尽量避免多次手术创伤，是唇腭裂外科医生们努力的方向[1]。, 百拇医药(陈晓璇 鲁勇 曹俊)
参见：首页 > 医疗版 > 疾病专题 > 口腔科 > 唇裂与腭裂 > 腭裂