Sommerlad-Furlow法在腭裂整复术中的应用

摘要

目的：采用Sommerlad-Furlow法对腭裂患者进行腭裂唇整复术，并对其手术方式及疗效进行了探讨。方法：腭裂患者67例，其中单侧完全性腭裂29例（左侧13例，右侧16例），不完全性腭裂38例；67例患者手术年龄为1～9岁，平均2.5岁。手术方法是先采用鼻咽侧壁松弛切口以此有效地缩小咽侧壁间的腭咽距离，再以Sommerlad法进行腭帆提肌的解剖复位和重建术，最后运用Furlow法即反向双Z成形术进行有效的进行软腭延长即Sommerlad-Furlow法。结果：本文中所有手术病例均无局部出血、感染、出血、复裂、穿孔。有4例局部创口糜烂；术后随访时间1～3个月，所有患者均无复裂及穿孔。结论：采用Sommerlad-Furlow法进行腭裂整复术可以在术中有效地进行腭帆提肌的解剖复位与重建，从而保证了各种腭裂鼻腔裂隙的完整封闭，极大地减少了腭裂术后复裂及穿孔的发生率并且最大限度地减少传统的硬腭松弛切口应用的概率。由于术中有效地延长软腭，从而为提高临床上腭裂整复术的腭咽闭合率以及今后患者的语音训练提高了很好的基础。至于该方法对腭裂患者远期临床疗效以及术后语音评估的影响需进一步观察研究。%Objective To explore the technique and effect of Sommerlad-Furlow's palatoplasty in repairing cleft palate. Methods Sommerlad-Furlow's palatoplasty had been performed in 67 patients with cleft palate including 29 cases of unilateral complete cleft palate (13 cases on the left side, 16 cases on the right side) and 38 cases of incomplete cleft palate; Surgery 1 years up to 4 years of age in 67 patients, average 2.5 years. Surgical method was combination of Sommerlad and Furlow technique, at ifrst lateral relaxing incision was carried out at the lateral nasopharynx wall, then Sommerlad technique was used to reconstruct levator veli palatine,and ifnally the soft palate was extended with Furlow's double-opposing Z-plasty.Results Local hemorrhage, infection, bleeding, postoperative cleft and perforation were not found in all cases. local tissue erosion was found in 4 cases; all Patients were followed up 1 to 3 months after operation, postoperative cleft and perforation were not found. Conclusions It suggestes that the Sommerlad-Furlow's palatoplasty is a useful procedure for the restoration and reconstruction of levator veli palatine to reach velopharyngeal competence, can greatly reduce the incidence of postoperative cleft and perforation and the traditional application of relaxing incision on the hard palate. Because the soft palate was effectively extended, the closure rate of velopharyngeal and voice training can be signiifcantly improved. As for the long-term curative effect and the evaluation of postoperative voice need to be studied further.