腭裂一期修复术后伤口愈合不良的风险因素分析

doi:10.7518/hxkq.2023.2023117

华西口腔医学杂志 ›› 2023, Vol. 41 ›› Issue (6): 719-724.doi: 10.7518/hxkq.2023.2023117

腭裂一期修复术后伤口愈合不良的风险因素分析

吴敏(), 尹恒, 陈丽先, 石冰, 李杨()

口腔疾病防治全国重点实验室国家口腔医学中心国家口腔疾病临床医学研究中心四川大学华西口腔医院唇腭裂外科，成都 610041

收稿日期:2023-04-15 修回日期:2023-06-13 出版日期:2023-12-01 发布日期:2023-11-27
通讯作者: 李杨 E-mail:min-min-1984@163.com;luciaya@163.com
作者简介:吴敏，主管护师，本科，E-mail：min-min-1984@163.com
基金资助:
四川大学高等教育教学改革工程（第十期）研究项目(SCU10176)

Analysis of risk factors affecting poor wound healing after primary cleft palate surgery

Wu Min(), Yin Heng, Chen Lixian, Shi Bing, Li Yang.()

State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China

Received:2023-04-15 Revised:2023-06-13 Online:2023-12-01 Published:2023-11-27
Contact: Li Yang. E-mail:min-min-1984@163.com;luciaya@163.com
Supported by:
Sichuan University Higher Education Teaching Reform(10th phase);Research Project(SCU10176);Correspondence: Li Yang, E-mail: luciaya@163.com

摘要/Abstract

摘要：

目的研究腭裂一期修复术后伤口愈合不良的风险因素。方法选取四川大学华西口腔医院唇腭裂外科2017—2021年采用Sommerlad-Furlow术式治疗的980例先天性腭裂患者为研究对象。记录患者的年龄、性别、体重、腭裂类型、裂隙最宽处宽度、腭裂指数（裂隙最宽处宽度/上颌结节平面后缘宽度）、术前白细胞数、术前血红蛋白水平、术前抗生素的使用、医生年资、术中松弛切口的使用、手术时长、术后上呼吸道感染和术后伤口愈合情况等。术后伤口愈合情况分为正常愈合、延迟愈合和腭瘘，延迟愈合和腭瘘均归为愈合不良。采用SPSS 26.0软件分析腭裂一期修复术后伤口愈合转归的影响因素。结果 980例腭裂患者中，正常愈合825例（84.2%），延迟愈合112例（11.4%），腭瘘43例（4.4%）。统计分析表明，医生年资、裂隙最宽处宽度、腭裂指数和手术时长对腭裂术后伤口愈合有影响（P<0.05），低年资医生、裂隙最宽处宽度较宽、腭裂指数大、手术时长较长是伤口愈合不良的危险因素。结论腭裂一期修复术后的伤口愈合效果与医生年资、裂隙最宽处宽度、腭裂指数和手术时长有关。

关键词: 腭裂, 一期修复, 伤口愈合不良, 风险因素

Abstract:

Objective To study the risk factors of poor wound healing after primary cleft palate surgery. Methods In this study, 980 cases of congenital cleft palate treated by Sommerlad-Furlow in the Department of Cleft Lip and Palate Surgery of Sichuan University from 2017 to 2021 were continuously analyzed. Indicators included patient’s age, gender, body weight, cleft palate type, width of the widest fistula, cleft palate index (width of the widest fistula/width at the posterior edge of the maxillary tubercle plane), preoperative white blood cell count, preoperative hemoglobin level, preoperative antibiotic use, doctor’s seniority, use of relaxation incision, operation time, postoperative upper respiratory tract infection, and postoperative wound healing. The postoperative wound healing was divided into normal healing, delayed healing, and palatal fistula. Both delayed healing and palatal fistula were classified as poor healing. The factors that may affect the healing outcome of the palatal wound after primary cleft palate repair were analyzed using SPSS 26.0 software. Results A total of 825 patients (84.2%) had normal healing, 112 patients (11.4%) had delayed hea-ling, and 43 patients (4.4%) had palatal fistula. Doctor’s seniority, width of the widest fissure, cleft palate index, and operation time influenced the wound healing effect after cleft palate surgery (P<0.05). Doctors with low seniority, wide width of the widest fistula, large cleft palate index, and long operation time were the risk factors of poor wound healing. Conclusion Doctor’s seniority, width of the widest fissure, cleft palate index, and operation time are related to the effect of healing effect after cleft palate surgery.

Key words: cleft palate, primary surgery, poor wound healing, risk factor

中图分类号:

R 782.2⁺2

吴敏, 尹恒, 陈丽先, 石冰, 李杨. 腭裂一期修复术后伤口愈合不良的风险因素分析[J]. 华西口腔医学杂志, 2023, 41(6): 719-724.

Wu Min, Yin Heng, Chen Lixian, Shi Bing, Li Yang.. Analysis of risk factors affecting poor wound healing after primary cleft palate surgery[J]. West China Journal of Stomatology, 2023, 41(6): 719-724.

图/表 3

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项目		n	正常愈合/（n/%）	延迟愈合/（n/%）	腭瘘/（n/%）	P值
性别	女性	550	468/85.0	63/11.5	19/3.5	0.271
	男性	430	357/83.0	49/11.4	24/5.6
裂隙类型	硬软腭裂	625	539/84.5	73/11.4	26/4.1	0.761
	单侧完全性腭裂	51	179/82.5	28/12.9	10/4.6
	双侧完全性腭裂	81	107/85.6	11/8.8	7/5.6
医生年资	高年资	152	133/87.5	13/8.6	6/3.9	<0.001
	中年资	632	555/87.8	56/8.9	21/3.3
	低年资	196	137/69.9^#	43/21.9^#	16/8.2*
术前使用抗生素	是	526	448/85.2	57/10.8	21/4	0.643
	否	454	377/83.0	55/12.1	22/4.8
术中使用松弛切口	是	94	81/86.2	11/11.7	2/2.1	0.531
	否	886	744/84.0	101/11.4	41/4.6
术后上呼吸道感染	有	172	136/79.1	28/16.3	8/4.7	0.083
术后上呼吸道感染	无	808	689/85.3	84/10.4	35/4.3

变量	正常愈合	延迟愈合	腭瘘	P值
年龄/岁	0.88（0.64~2.04）	0.88（0.64~1.34）	0.88（0.64~3.46）	0.694
体重/kg	9（8.25~12.0）	9（8~11.1）	9（7.95~11.9）	0.372
术前白细胞计数/（×10⁹/L）	9.04（7.45~11.41）	9.68（7.91~11.84）	8.87（7.38~10.16）	0.118
术前血红蛋白水平/（g/L）	124（116~130）	123（116.5~130）	123（113.5~131）	0.943
裂隙最宽处宽度/mm	11（9~13）	11（9~13）	12（9.5~15）	0.014
上颌结节平面后缘宽度/mm	34（31~38）	34（30~38）	35（32~38.5）	0.490
腭裂指数	0.301（0.258~0.375）	0.321（0.276~0.394）	0.342（0.281~0.417）	0.022
手术时长/min	75（60~90）	85（70~100）	95（80~110）	<0.001

变量		OR	95%CI	P值
延迟愈合	手术时长	1.008	1.000~1.018	0.064
	医生年资
	高年资	0.418	0.206~0.850	0.016
	中年资	0.293	0.177~0.484	<0.001
	低年资	参照
	裂隙最宽处宽度	1.056	0.913~1.221	0.461
	腭裂指数	1.079	0.026~45.059	0.968
腭瘘	手术时长	1.017	1.004~1.030	0.008
	医生年资
	高年资	0.591	0.209~1.671	0.321
	中年资	0.324	0.150~0.701	0.004
	低年资	参照
	裂隙最宽处宽度	1.037	0.919~1.169	0.556
	腭裂指数	8.915	0.818~97.170	0.073

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腭裂一期修复术后伤口愈合不良的风险因素分析

Analysis of risk factors affecting poor wound healing after primary cleft palate surgery

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