华西Sommerlad-Furlow腭裂修复术后腭瘘率的研究

目的 探索华西Sommerlad-Furlow （SF）腭裂修复术后的腭瘘发生率及影响因素。方法 随访四川大学华西口腔医院唇腭裂外科2017年4—12月的385例一期腭裂病例,观察华西SF腭裂修复术后的腭瘘率,并分析可能影响伤口愈合的因素,包括性别、体重、手术年龄、裂隙类型、手术医生资历、术前白细胞计数、术前是否预防性使用抗生素、术后体温。结果 采用华西SF腭裂修复术的总瘘孔率为3.9%（15/385）;在15例腭瘘患者中,1例瘘孔位于牙槽近硬腭,12例位于硬腭,2例位于硬软腭交界。腭瘘的发生与性别、体重、手术年龄、术前是否预防性使用抗生素、术前白细胞计数、术后体温均无关（P>0.05）。在手术医生资历这一影响因素中,正高级职称（3.03%）与副高级职称（2.23%）的瘘孔率之间的差异无统计学意义（P>0.05）,但中级职称的瘘孔率为14.29%,明显高于正高级职称和副高级职称（P<0.05）。双侧完全性腭裂的瘘孔率（20.6%）大于单侧完全性腭裂（3.6%）及硬软腭裂（2.6%）（P<0.05）。结论 华西SF腭裂修复术不做松弛切口,可避免上颌骨的生长抑制,同时并未增加腭裂术后的瘘孔率,其瘘孔发生率与患儿性别、体重、手术年龄、术前是否预防性使用抗生素、术前感染、术后体温等因素关联不大,与术者的年资和腭裂的不同类型有一定相关性。

Palatal fistula rate after Huaxi Sommerlad-Furlow palatoplasty

Objective This study aimed to determine the palatal fistula rate, explore the influencing factors of Huaxi Sommerlad-Furlow (SF) palatoplasty. Methods A retrospective review of 385 consecutive cleft-palate cases was performed to determine the incidence of postoperative fistula and assess the possible contributing factors, such as sex, weight, age, cleft type, operator skills, preoperative white blood cell, preventive antibiotic use, and postoperative temperature. Results Fistulas occurred in 15/385 patients (3.9%). Among them, 1 fistula was located at the junction of the hard and soft palates, 12 fistulas in hard palate, and 2 fistulas in alveolar near the hard palate. No evidence suggested that sex, weight, age, preoperative white blood cell, preventive antibiotic use, and postoperative temperature are associated with fistula formation. The incidences of cleft palate fistulas as encountered by senior professors (3.03%) and associate senior professors (2.23%) were significantly lower than those by attending doctors (14.29%, P<0.05). The incidences of cleft palate fistulas in bilateral completely cleft palate cases (20.6%) were significantly higher than those in hard and soft (3.6%) and unilateral cleft palate cases (2.6%, P<0.05). Conclusion Huaxi SF palatoplasty can avoid the inhibited maxillary growth without requiring lateral relaxing incision, which poses an acceptable risk of fistula formation. The palatal fistula rate is not related to the sex, weight, age of operation, prophylactic use of antibiotics before operation, infection before operation, temperature after operation and other factors. The occurrence of the fistula is related mainly to cleft type and experience level of the surgeon.