咽后壁瓣咽成形术后通气障碍断蒂治疗的效果评价及预后因素分析

doi:10.7518/hxkq.2024.2024218

摘要/Abstract

摘要：

目的断蒂是治疗咽后壁瓣咽成形术后通气障碍的主要手段，但目前对其治疗效果及预后相关因素的讨论有限。本研究旨在探讨断蒂治疗改善咽成形术后通气障碍和低鼻音的有效性，并分析影响术后并发症出现的危险因素。方法回顾本单位咽后壁瓣咽成形术后通气障碍采取断蒂治疗的腭裂患者，使用鼻通气阻塞症状评估量表、语音评估表、鼻咽纤维镜和头颅侧位片对患者术前术后的通气、语音及相关因素进行评估。使用鼻咽纤维镜观察患者通气孔阻塞情况、腭咽闭合功能、咽侧壁动度，使用头颅侧位片评估患者上下颌骨关系及腺样体大小。建立单因素和多因素Logistics回归模型筛选影响术后出现持续性通气障碍和高鼻音的预后因素。结果研究共纳入63名患者。断蒂治疗术后56名患者（88.9%）通气障碍严重程度有效降低，但其中20名患者（31.7%）仍在术后表现出中重度以上通气障碍，手术年龄（P=0.023）和腺样体肥大（P=0.003）与术后持续性通气障碍显著相关。39名术前低鼻音患者均在术后得到有效改善，11名患者（17.5%）在断蒂术后出现轻度高鼻音，单侧通气孔堵塞（P=0.004）和BMI（P=0.027）可能是术后出现高鼻音的独立影响因素。结论断蒂是改善咽后壁瓣咽成形术后通气障碍和低鼻音的有效手段，但部分患者断蒂后可能仍存在持续性通气障碍及出现高鼻音。手术年龄和腺样体肥大是断蒂术后持续性通气障碍的预后相关因素，单/双侧通气孔阻塞和BMI是断蒂术后出现高鼻音的相关因素。

关键词: 咽成形术, 通气障碍, 咽瓣术后断蒂治疗, 高鼻音

Abstract:

Objective Flap division is the primary method for treating postoperative airway obstruction following pharyngeal flap surgery. However, a discussion on the treatment effectiveness and prognosis of this surgery is lacking. Therefore, this study aims to explore the effectiveness of flap division in improving airway obstruction and hyponasality after pharyngoplasty and to analyze the risk factors for postoperative complications. Methods A retrospective review was conducted on the data of all patients who underwent flap division following pharyngeal flap for airway obstruction at our institution. Pre- and post-operative assessments of ventilation, speech, and related factors were performed using the nasal obstruction symptom evaluation scale, speech evaluation scale, nasopharyngeal fiberscope, and lateral cephalometric radiographs. A nasopharyngeal fiberscope was utilized to observe the airway port of the patients, velopharyngeal closure, and the mobility of the lateral pharyngeal walls. Lateral cephalometric radiographs were employed to evaluate the patient’s maxillomandibular relationship and adenoid dimensions. A logistic regression model incorporating univariate analysis and multivariate analyses was established to identify the prognostic factors influencing the occurrence of persistent postoperative airway obstruction and hypernasality. Results Among the 63 patients, 56 patients (88.9%) experienced a reduction in the severity of airway obstruction postoperatively but 20 patients (31.7%) still presented with moderate-to-severe airway obstruction. Age at surgery (P=0.023) and adenoid hypertrophy (P=0.003) were significantly associated with persistent postoperative airway obstruction. All 39 individuals exhibiting preoperative hyponasality demonstrated effective resolution after flap division, and 11 patients (17.5%) experienced mild hypernasality postoperatively. Unilateral port obstruction (P=0.004) and BMI (P=0.027) were identified as potential independent factors influencing the development of postoperative hypernasality. Conclusion Flap division is an effective measure for improving postoperative airway obstruction and hyponasality following pharyngeal flap, although some patients may continue to experience persistent airway obstruction and develop hypernasality after division. Age at surgery and adenoid hypertrophy are prognostic factors for persistent airway obstruction following flap division. Unilateral/bilateral nasal airway obstruction and BMI are related factors for post-operative hypernasality.

Key words: pharyngoplasty, airway obstruction, flap division after pharyngeal flap, hypernasality

中图分类号:

R782.2

李亚楠, 石冰, 李精韬. 咽后壁瓣咽成形术后通气障碍断蒂治疗的效果评价及预后因素分析[J]. 华西口腔医学杂志, 2024, 42(6): 755-763.

Li Yanan, Shi Bing, Li Jingtao. Assessment of the efficacy and analysis of prognostic factors of flap division for postoperative airway obstruction following posterior pharyngeal flap[J]. West China Journal of Stomatology, 2024, 42(6): 755-763.

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项目	术前	术后	P值
通气分数	65.5±17.2	21.7±19.8	<0.001
通气分级			<0.001
无症状	0（0.0%）	16（25.4%）
轻度	0（0.0%）	27（42.9%）
中度	23（36.5%）	15（23.8%）
重度	17（27.0%）	5（7.9%）
极端	23（36.5%）	0（0.0%）

语音及腭咽闭合功能		术前	术后	P值
低鼻音	有	39（61.9%）	0（0.0%）	<0.001
低鼻音	无	24（38.1%）	63（100.0%）	<0.001
高鼻音	无	63（100.0%）	52（82.5%）	<0.001
	轻度	0（0.0%）	11（17.5%）	<0.001
	中/重度	0（0.0%）	0（0.0%）
鼻漏气	有	0（0.0%）	11（17.5%）	<0.001
鼻漏气	无	63（100.0%）	52（82.5%）	<0.001
构音障碍	有	19（30.2%）	12（19.0%）	0.148
构音障碍	无	44（69.8%）	51（81.0%）	0.148
腭咽闭合	腭咽闭合完全	63（100.0%）	52（82.5%）	<0.001
	临界腭咽闭合	0（0.0%）	11（17.5%）	<0.001
	腭咽闭合不全	0（0.0%）	0（0.0%）

相关因素	通气障碍（n=47）	无通气障碍（n=16）	比值比（95%置信区间）	P值
手术年龄/岁	10（8.0，14.0）	12.5（11.0，17.3）	-	0.023
断蒂术后随访时长/年	24.0（12.0，48.0）	36.0（12.25，72.0）	-	0.355
性别男性	24（51.1%）	10（62.5%）	1.597（0.499~5.108）	0.428
女性	23（48.9%）	6（37.5%）
通气孔阻塞单侧阻塞	17（36.2%）	9（65.3%）	0.441（0.139~1.396）	0.159
双侧阻塞	30（63.8%）	7（43.8%）
腺样体肥大是	18（38.3%）	0（0.0%）	-	0.003
否	29（61.7%）	16（100.0%）
BMI <18	19（40.4%）	6（37.5%）		0.822
18~24	23（48.9%）	9（56.3%）
>24	5（10.6%）	1（6.3%）
上下颌骨关系安氏Ⅰ类	21（44.7%）	5（31.3%）		0.372
安氏Ⅱ类	6（12.8%）	1（6.3%）
安氏Ⅲ类	20（42.6%）	10（62.5%）
咽侧壁动度弱	8（17.0%）	3（18.8%）		0.868
中	27（57.4%）	8（50.0%）
好	12（25.5%）	5（31.3%）

相关因素	通气障碍（n=47）	无通气障碍（n=16）	比值比（95%置信区间）	P值
手术年龄/岁 <12	31（66.0%）	6（37.5%）	0.270（0.075~0.973）	0.045
≥12	16（34.0%）	10（62.5%）
腺样体肥大是	18（38.3%）	0（0.0%）	934 779 523.5（0.000）	0.998
否	29（61.7%）	16（100.0%）

手术年龄/岁	腺样体肥大	通气障碍（n=47）	无通气障碍（n=16）	比值比（95%置信区间）	P值
<12	是	11/31（35.5%）	0/6（0.0%）	1.550（1.194~2.012）	0.151
	否	20/31（64.5%）	6/6（100.0%）	1.550（1.194~2.012）	0.151
≥12	是	7/16（43.8%）	0/10（0.0%）	1.778（1.154~2.739）	0.023
	否	9/16（56.3%）	10/10（100.0%）	1.778（1.154~2.739）	0.023