先天性唇腭裂综合序列治疗502例临床护理程序效果观察

目的:总结采取综合序列治疗502例先天性唇腭裂患者手术前后临床护理经验,旨在进一步提高护理质量。方法:对502例先天性唇腭裂患者行手术整复,并给予手术前后临床护理程序,包括健康宣教、心理护理、术前护理、术后护理、出院指导等。结果:本组患者临床效果均满意,414例患者唇部创口一期愈合,外貌明显改善,11例腭裂术后发生腭瘘或复裂,其余患者创口愈合良好,语音明显改善。结论:规范的手术前后临床护理程序有助于唇腭裂患者整复手术的成功。     

先天性唇腭裂506例围术期护理

目的：探讨先天性唇腭裂患儿围术期的护理方法。方法：通过对506例先天性唇腭裂患儿围术期的护理工作进行总结,探讨有效的护理措施。结果：术后唇裂患儿5d拆线,住院7—9d;腭裂患儿不拆线,住院18d。唇裂均I期愈合,腭裂仅2例发生软硬腭交界处穿孔。结论：对先天性唇腭裂患儿采取有效的围术期护理,是保证手术成功的前提和惠儿康复的关键。     

小儿泰诺林滴剂用于唇腭裂患儿术后的临床观察

唇腭裂是口腔颌面部常见的先天性畸形,对其行手术修复是唇腭裂序列治疗中的关键部分[1],然而 临床上常可见患儿在术后出现发热、伤口疼痛、躁动等症状,为减少有碍于创口愈合的不良刺激,借鉴"微笑行动"的临床经验,本研究对唇腭裂整复术后的患儿给予口服小儿泰诺林(由上海强生制药有限公司生产)退热滴剂并进行临床观察与比较,现报道如下.     

先天性唇腭裂患者的围术期护理

目的探讨28例先天性唇腭裂患者围术期的护理经验。方法对先天性唇腭裂手术患者28例行围术期护理干预,观察护理干预对术后疼痛、术中出血量、手术时间、住院时间、并发症及预后的影响。结果随着术后时间的延长,患儿疼痛程度显著下降,由重度疼痛过渡到轻度疼痛;手术时间50～120 min,平均60 min;术中出血量45～110 m L,平均55 m L;住院时间7～16 d,平均(9. 4±2. 6) d。伤口Ⅰ期愈合,患儿外貌改善显著,语言清晰度较术前显著提高,所有患者均顺利出院。术后随访6个月～3年,所有患儿恢复良好,在语言功能方面均有不同程度的改善,患儿及家属对外形均较满意。术后并发症发生2例(7. 1%)。结论手术前后对先天性唇腭裂患儿进行专业优质的护理,对患儿病情的恢复和预后均有显著作用。     

小儿唇腔裂手术前后的护理

随着社会的进步、生活的提高、医疗水平的进展,先天性唇腭裂整复手术(以下简称唇腭裂手术),年龄越来越小。唇裂在出生后数月、腭裂在,岁以内,术日益增多。本院近十年,做小儿唇腭裂手术448例,婴幼儿占241例,本组均痊愈出院。现将手术前后护理总结如下。     

先天性唇腭裂506例围术期护理

目的:探讨先天性唇腭裂患儿围术期的护理方法.方法:通过对506例先天性唇腭裂患儿围术期的护理工作进行总结,探讨有效的护理措施.结果:术后唇裂患儿5 d拆线,住院7～9 d ;腭裂患儿不拆线,住院 18 d .唇裂均Ⅰ期愈合,腭裂仅2例发生软硬腭交界处穿孔.结论:对先天性唇腭裂患儿采取有效的围术期护理,是保证手术成功的前提和患儿康复的关键.     

318例婴幼儿腭裂整复术围手术期护理

目的通过对婴幼儿腭裂患者于手术前后实施困手术期护理的探讨,探索出一套适合腭裂手术患者手术前后行之有效的临床护理路径。方法回顾本院2007年12月至2008年12月间年龄在0～3岁的婴幼儿腭裂手术患者共计318例,再对腭裂整复手术前、后患者的护理经验进行理论分析与总结。结果通过以上围手术期的护理,患者出现术后出血、呼吸道梗阻、创口感染、创口裂开等近期并发症均有明显的降低,术后恢复良好。结论充分的术前护理,密切的术后病情观察及护理,详细的出院指导,是预防和减少并发症的发生,腭裂手术治疗取得成功的保证。     

婴幼儿唇腭裂修复术围手术期的呼吸道管理

目的 探讨婴幼儿唇腭裂修复术围手术期呼吸道管理的护理要点.方法 对175例唇腭裂患儿病例进行回顾性分析和总结,并不断改进护理方法.结果 175例患儿唇腭裂修复术后未并发感染,创口均一期愈合,其中腭部松弛切口出血2例,术后低氧血症2例,术后发生喂食管反流误吸1例,经及时发现,积极处理均痊愈出院.结论 唇腭裂修复术围手术期的并发症主要与呼吸道的并发症相关,完善术前准备,加强围手术期护理,尤其加强呼吸道的管理,可有效减少术后并发症的发生,提高患儿手术的安全性.     

先天性唇腭裂整复术290例围术期喂养与护理

2008年6月～2009年5月,我院对290例先天性唇腭裂患者行唇腭裂整复术,经精心喂养与护理,取得满意效果.现将围术期喂养与护理体会报告如下. 1 临床资料 本组先天性唇腭裂患者290例,男180例,女110例;年龄6个月～37岁.唇裂192例,腭裂98例.     

1例阴茎假体植入术围手术期护理

介绍1例采用阴茎假体植入术治疗性功能障碍的围手术期护理。主要阐述了手术前后的护理重点：即术前做好心理护理，术区严格备皮，卧床生活指导，术后进行一般护理和对阴茎血运、创口的观察护理。该患者术后创口愈合良好，6周恢复性生活。     

Improving cleft palate/cleft lip antenatal diagnosis by 3-dimensional sonography: the "flipped face" view.

OBJECTIVE: Three-dimensional sonography has enhanced the diagnosis of congenital anomalies in the early stages of pregnancy. Both cleft lip and palate remain a diagnostic challenge for the sonographer because of the variable size of the defects as well as their location. Recently, a technique described by Campbell et al (Ultrasound Obstet Gynecol 2003; 22:552-554, 2005; 25:12-18) demonstrated an improved method called the "reverse face" view, which appears to assist in the diagnosis of clefts involving the palate. METHODS: The fetal face was initially examined with the fetus in the supine position. Using 3-dimensional sonography, a static volume was acquired. Following acquisition of the volume, it was rotated 90 degrees so that the cut plane was directed in a plane from the chin to the nose. The volume cut plane was then scrolled from the chin to the nose to examine in sequential order the lower lip, mandible, and alveolar ridge; tongue; upper lip, maxilla, and alveolar ridge; and hard and soft palates. RESULTS: This approach identified the full length and width of the structures of the mouth and palates and allows the examiner to identify normal anatomy as well as clefts of the hard and soft palates. CONCLUSIONS: The fetal hard and soft palates of the mouth can be accessed using a new technique, which we call the "flipped face" maneuver, when an adequate volume of the face can be obtained.     

2008-2011年广东省珠海市围产儿唇腭裂监测流行病学特征分析

目的 了解广东省珠海市2008-2011年围产儿唇腭裂的流行病学特征。 方法 利用珠海市出生缺陷监测系统获得围产儿唇腭裂资料并进行统计分析。 结果 珠海市2008-2011年围产儿总唇腭裂222例,发病率为21.77/万,各年度发病率差异无统计学意义;不同性别、产妇各年龄组发病率差异无统计学意义,城镇组发病率高于农村组;40.50%唇腭裂患儿在围生期死亡。 结论 珠海市围产儿唇腭裂发病率水平相对稳定,发病率较高,应采取综合措施加强围产儿唇腭裂的三级预防。     

IRF6和RARA基因多态性与非综合征性唇腭裂的相关性研究

目的探讨干扰素调节因子-6(IRF6)基因rs2235371位点和视黄酸受体-α(RARA)基因rs2229773位点单核苷酸多态性(SNP)与非综合征性唇腭裂的关系,以及2个位点在患者和健康者之间的基因型和等位基因型频率差异。方法选取153例非综合征性唇腭裂(NSCL/P)患者作为NSCL/P组,体检健康者150例作为健康对照组。运用聚合酶链式反应-限制性片段长度多态性(PCR-RELF)技术,分析IRF6、RARA基因的多态性,比较2组研究对象基因型和等位基因型频率差异。结果 IRF6基因rs2235371位点基因型CC、TT和等位基因C、T频率在NSCL/P组和健康对照组的分布,差异有统计学意义(P0.05),NSCL/P组等位基因C频率高于健康对照组,差异有统计学意义(P0.05)。RARA基因rs2229773位点基因型CT、TT频率在NSCL/P组和健康对照组的分布,差异有统计学意义(P0.05),NSCL/P组基因型为CT杂合子,显著多于健康对照组,差异有统计学意义(P0.05)。结论 NSCL/P与IRF6基因rs2235371位点等位基因C及RARA基因rs2229773位点CT基因型具有相关性。     

超声诊断儿童鳃裂畸形

目的 探讨儿童鳃裂畸形的超声诊断价值.方法 回顾15例鳃裂畸形患儿的声像图表现,并与手术、病理结果对照分析.结果 6例为鳃裂囊肿,超声表现为囊性团块,内回声均匀;6例为鳃裂囊肿并瘘管形成,超声表现为囊性团块,并有条状低回声与体表或咽内相通;3例为鳃裂窦道形成.全部鳃裂畸形患儿中13例病灶位于颈前,1例位于锁骨下缘前胸壁,1例位于耳前腮腺区.超声诊断与手术病理符合率为86.70%.结论 超声诊断鳃裂畸形较准确、可靠,可明确其位置及毗邻关系,对临床手术有重要意义.     

Bilateral cleft lip and palate diagnosed sonographically at 11 weeks of pregnancy

Cleft lip with or without cleft palate is the most common facial malformation in newborns. We report a case of bilateral cleft lip and palate that was detected via transvaginal sonography at 11 weeks and 5 days of gestation. The sonographic findings were confirmed at autopsy.     

唇腭裂的超声筛查及诊断价值

目的：研究常规鼻唇冠状切面加特殊切面在胎儿唇腭裂畸形筛查中的应用价值.材料与方法：对11688例,孕24 ～ 30周胎儿唇腭部采用常规鼻唇冠状切面加特殊切面（经唇部冠状面、经双眼标准横断面、经鼻腔标准横断面、经上牙槽突标准横断面、经舌标准横断面、经下牙槽突标准横断面和经鼻正中矢状面）行产前超声筛查,并与出生儿颜面部检查结果进行对照分析,总结鼻唇冠状切面加特殊切面超声扫查法的诊断符合率.结果：11688例胎儿共查出59例阳性患者,阳性率0.50％（59/11688）,单纯唇裂13例,占阳性病例的22.03％ （13/59）,唇裂合并腭裂的46例,占阳性病例的77.97％（46/59）,左侧唇腭裂38例,占64.4％ （38/59）,右侧唇腭裂10例,占16.9％（10/59）,正中唇裂2例占3.39％（2/59）,双侧唇腭裂9例,占12.25％（9/59）.结论：超声诊断胎儿唇腭裂畸形通过观察鼻唇部冠状切面加特殊切面（上牙槽突标准横断面、下牙槽突标准横断面、鼻腔横断面、双眼标准横断面、舌标准横断面、胎儿头颅矢状面）及配合一定手法,可明显提高其诊断率.     

Branchial cleft cyst

Branchial cleft cysts are benign lesions caused by anomalous development of the brachial cleft. This report describes a 20-year-old girl with swelling on the right lateral aspect of the neck, which expanded slowly but progressively. The clinical suspicion was that of a branchial cleft cyst. Sonography revealed a homogeneously hypo- to anechoic mass with well-defined margins and no intralesional septa. Color Doppler reviewed no internal vascularization. The ultrasound examination confirmed the clinical diagnosis of a second branchial cleft cyst, demonstrating the cystic nature of the mass and excluding the presence of complications. For superficial lesions like these, ultrasound is the first-level imaging study of choice because it is non-invasive, rapid, low-cost, and does not involve exposure to ionizing radiation.     

The premaxillary triangle: clue to the diagnosis of cleft lip and palate.

OBJECTIVE: The prenatal detection rate of cleft lip and palate is low, especially in low-risk patients who undergo targeted sonography. The reason is that evaluating surface anatomy is relatively difficult and requires operator expertise. Our purpose was to describe a technique to improve the diagnostic accuracy of facial clefts (lip and palate) and to assess the feasibility of including this technique as part of standard protocol during targeted imaging. METHODS: A prospective study was done during 2000 through 2002 to evaluate the accuracy of the "premaxillary triangle (PMT) sign": a new sign to diagnose unilateral cleft lip and palate in women referred for prenatal sonography at our center. Patients with only isolated unilateral cleft lip and palate and cleft lip were included in this study. Before this, all examiners were trained to image the PMT. The images were reviewed by a senior consultant. It was later decided to include this sign as part of the protocol of targeted sonography done between 18 and 22 weeks in our institution. However, depending on the fetal position, the PMT was documented even in patients referred for the first time in late second and third trimesters. RESULTS: Twenty-nine cases of isolated facial clefts were diagnosed during the study period, of which 2 had unilateral cleft lip and 27 had unilateral cleft lip and palate. The PMT sign was absent in all cases of unilateral cleft lip and palate but was present in 2 cases of isolated cleft lip without cleft palate. CONCLUSIONS: The PMT sign can be easily incorporated into targeted sonography at 18 to 22 weeks' gestation. Its inclusion would help in increasing the detection rate of unilateral cleft lip and palate. It may also be potentially used for differentiating between isolated cleft lip and cleft lip and palate, which helps in better prenatal counseling.     

The process leading to affirmation of life with cleft lip and cleft palate: The importance of acquiring coherence

Aims: The objectives of this study were to understand the experiences of people with cleft lip and cleft palate (CLCP) and to describe the processes and factors leading to the acquisition of high self‐esteem. Methods: Semi‐structured interviews were conducted of 19 subjects with CLCP recruited via hospitals and through snowball sampling, and the results were analyzed qualitatively, comparing high and low self‐esteem groups. Results: Participants with high self‐esteem had gone through the phases of “noticing their difference from others”, “knowing about and deepening their understanding of CLCP”, “no denial of their life with CLCP” and “affirmation of life with CLCP”. Seven factor categories including “received sufficient explanation of CLCP condition (from parents) in the early stage”, “have not received negative messages about CLCP” and “feeling the presence of someone who accepts their feelings and supports them” were extracted as factors promoting these processes. Conclusions: Knowing about and understanding CLCP enables individuals to acquire a sense of coherence in their lives, which may be related to gaining a feeling of control over their cleft condition, acquiring a sense of autonomy, and finding a meaning for their lives. Thus, medical professionals should provide explanations that enable patients to understand CLCP, and also facilitate interaction between patients with the same condition.