大龄腭裂患者两种手术模式的临床评估

目的 探讨不同年龄腭裂患者的手术治疗模式,以提高大龄腭裂患者术后的腭咽闭合率和语音清晰度.方法 2010年5月至2012年4月,52例大龄腭裂患者按年龄不同分为A组(8～16岁,n=18)和B组(16岁以上,n=34),A组进行改良兰氏法同期腭咽肌瓣咽成形术,B组进行改良兰氏法同期咽后壁瓣咽成形术.所有患者术后随访10～18个月,观察创口愈合情况、语音清晰度、高低鼻音、鼻漏气及鼻咽纤维内镜检查情况.结果 语音评估显示,A组和B组患者高鼻音和鼻漏气程度均显著下降,语音清晰度提高；32例患者术后腭咽闭合完全,余20例患者术后虽仍有腭咽闭合不全,但在鼻咽纤维镜下腭咽闭合率达80％以上.结论 针对不同年龄的腭裂患者制定个体化手术方式,可显著提高腭裂患者术后腭咽闭合率和语音清晰度.

Evaluation of Two Different Surgica l Procedures Repairing Cleft Palate in Patients over Eight Years Old

Objective To establish the optimized surgical procedure in patients with cleft palate over eight years old and to improve the palatal pharynx closed rate and speech intelligibility.Methods From May 2010 to April 2012,52 patients with cleft palate over eight years old were divided into two groups according to different age.Patients were treated with palatoplasty and sphincter pharyngoplasty（Group A,8-16 years old,n =18） or posterior pharyngeal flap transplantation（Group B,more than 16 years old,n=34）.All the patients were followed up for 10 to 18 months,the outcome of the surgery was assessed by perceptual speech assessment,nasopharyngoscopy and wound healing observation.Results Perceptual speech assessment showed the rate of hypernasality and nasal emission decreased significantly,and the consonant articulation increased.Thirty-two patients got complete velopharyngeal closure,and the velopharyngeal closure ratios of the other 20 patients were over 80% according to nasopharyngoscopy.Conclusion Different procedures based on different ages could correct the velopharyngeal incompetence and improve the articulation of the patients.