大年龄腭裂患者术后腭咽闭合功能的影响因素

目的 研究2岁以上腭裂患者术后腭咽闭合功能的影响因素。方法 对245例2岁以上腭裂患儿术后腭咽闭合功能和可能影响术后腭咽闭合功能的因素（腭咽比值、腭裂类型、手术年龄、术式）进行回顾性研究。结果 腭咽闭合不全（ VPI）组和腭咽闭合完全（ VPC）组术前相对裂隙宽度、腭咽比值差异无统计学意义。不同年龄组、不同腭裂类型术后腭咽闭合率未见明显差异。不同的术式术后腭咽闭合率差异有统计学意义。结论 大年龄腭裂患者的治疗不宜照搬 2岁以下患儿单纯行腭裂整复术的常规治疗方案。裂隙的大小不是影响大年龄腭裂患者术后腭咽闭合功能的主要因素。 Sommerlad腭帆提肌重建术 +腭咽肌瓣咽成形术可明显改善大年龄患者术后腭咽闭合功能,在一期手术时应采用这种腭咽联合手术。     

大龄腭裂患者治疗模式的初步研究

目的改进大龄腭裂患者的治疗模式,提高大龄腭裂患者术后的腭咽闭合率和语音清晰度。方法对37例年龄大于6岁（含6岁）的腭裂患者进行同期腭裂与腭咽肌瓣咽成形整复术,并对其术后10~15个月的效果进行了随访和语音评估。结果22例患者术后腭咽闭合完全,15例术后虽仍有腭咽闭合不全,但在鼻咽纤维镜下腭咽闭合度达85%以上;所有患者X线侧位咽腔造影显示软腭与咽后壁贴合;语音检测显示,高鼻音和鼻漏气程度显著下降,辅音清晰度提高。结论本研究中建立的大龄腭裂患者治疗模式可以显著提高腭裂患者术后的腭咽闭合率和语音清晰度,为改善其生存质量创造了条件。     

改良咽后壁组织转移瓣在VPI患者的临床应用和研究

目的：客观评价改良咽后壁组织转移瓣效果。方法：对30例行改良咽成形术者术前、术后的吹气试验，汉语语音清晰度以及过度度鼻音进行了定量分析。结果：改良咽后壁组织转移瓣术后的吹气试验，汉语语音清晰度以及过度鼻音有了明显的改善。结论：改良咽后壁组织转移瓣能有效地改善VPI患者的腭咽闭合功能。     

带蒂扁桃体复合组织瓣治疗腭裂术后腭咽关闭不全

目的：探讨腭裂术后腭咽关闭不全的再手术治疗方法。方法：12例腭裂术后腭咽关闭不全患者，手术从下极将腭咽弓黏膜肌肉与扁桃体一同翻起，形成一个蒂在上方的带腭咽肌的复合组织瓣，保留扁桃体上1／3作蒂．将扁桃体复合瓣向后上旋转，在软腭平面缝合于咽后壁创面，两侧腭咽肌在中线拉拢缝合，扁桃体之间留小缝隙。结果：所有病例术后次日开放性鼻音消失．但均有不同程度睡眠打鼾。术后1～1．5年复查．11例患者发音功能基本同正常人，1例患者仍有开放鼻音，扁桃体均部分萎缩，两侧扁桃体之间间隙5～10mm，其中3例扁桃体部分下垂。有6例患者仍有轻度睡眠打鼾现象。结论：蒂在上方扁桃体复合组织瓣治疗腭裂术后腭咽关闭不全，术后发音功能改善明显．是一种有效的治疗方法．     

腭帆提肌止点后上推移术与传统腭裂整复术的比较

目的 :研究腭裂功能性整复术 ,提出一种新术式———腭帆提肌止点后上推移术。方法 :在腭帆提肌及相关肌肉尸体解剖基础上 ,应用腭帆提肌止点后上推移腭裂整复术实施 2 0例 ,术后应用鼻咽镜、语音分析进行腭咽闭合功能及语音评价 ,与传统术式进行对照研究。结果 :2 0例手术术后均一期愈合。鼻咽镜检查示全部病例腭咽肌肉运动良好 ,发音时达到完全腭咽闭合 ,语音均得到改善。结论 :腭帆提肌止点后上推移术使软腭充分向后上提拉完成腭咽闭合 ,较好地解决了传统术式术后存在腭咽闭合功能不全的问题 ,是一种较好的腭裂功能性修复方法     

Hogan法治疗大龄腭咽闭合不全患者的临床疗效分析

目的 探讨使用Hogan法咽后壁组织瓣转移术治疗大龄腭咽闭合不全（VPI）患者的临床疗效。方法收集33例腭裂术后VPI患者，年龄10～35岁，平均年龄20.4岁。所有患者均行Hogan法咽后壁组织瓣转移术治疗腭咽闭合不全。采用汉语语音清晰度测定法评估患者语音情况，鼻咽纤维镜（NPF）评估腭咽闭合程度，并进行分级。平均随访时间13.3个月。结果 33例患者术后创口均达到Ⅰ期愈合。术后语音清晰度明显提高，鼻漏气及高鼻音减少，与术前相比差异有统计学意义（P<0.05）。NPF检查示，术后腭咽闭合功能明显改善，30例（91%）患者腭咽闭合率达到Ⅰ级，3例（9%）患者达到Ⅱ级。结论 Hogan法咽后壁组织瓣转移术可显著改善大龄VPI患者的腭咽闭合状况，减少鼻漏气和高鼻音。     

不同咽成形术式对腭裂术后继发腭咽闭合功能不全合并睡眠呼吸障碍的影响

目前国际上治疗腭裂继发腭咽闭合不全的常用术式包括咽后壁瓣成形术、腭咽肌瓣成形术和Furlow瓣（双反向Z形瓣）。多导睡眠监测（polysomnography, PSG）结合主诉症状表明,部分腭裂术后腭咽闭合不全患者在接受咽成形术后会出现不同程度的阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome, OSAHS）,轻症者可自行缓解,严重者需采用吸氧或呼吸机治疗,极少数需手术摘除或松解咽瓣。儿童与成人在咽后壁瓣成形术后发生OSAHS的概率无显著差异,但儿童的病情较成人严重。术前已有OSAHS的患者,咽成形术后症状可能加重。在对不同术式患者的短期随访（≤6个月）中发现,Furlow瓣术后发生OSAHS的概率最低,腭咽肌瓣成形术次之,咽后壁瓣成形术最高。大于1年的随访显示,3种手术后OSAHS发病率无显著差异。目前对腭裂患者腭咽闭合不全的手术治疗尚无统一术式,各种手术方法术后OSAHS的发病率仍存在争议,应将PSG检查作为咽成形术围术期常规检查,以便更准确地评估不同术式对睡眠呼吸障碍的影响。     

联合应用Sommerlad与Furlow术式治疗腭咽闭合不全

目的基于Sommerlad腭帆提肌重建和Furlow反向双"Z"两种术式的优缺点,探讨联合两种术式的改良设计治疗腭咽闭合不全的可行性和有效性。方法对腭裂修复术后确诊腭咽闭合不全的患者,采用Sommerlas术式重建腭帆提肌,恢复肌肉功能的同时,采用Furlow术式延长软腭,重建腭咽闭合生理功能的解剖学结构。术后3个月经鼻咽纤维镜检查评估腭咽闭合功能。结果改良的联合术式设计可明显提高腭咽闭合不全患者的腭咽闭合率。结论将2种不同术式联合应用,有很强的可行性和可操作性,组织精细解剖复位和准确可靠的缝合技术是确保该术式成功实施的关键。可用于腭裂术后继发腭咽闭合不全的治疗。     

腭咽阻塞器在腭裂术后腭咽闭合不全语音障碍中的治疗作用

目的 :探讨腭咽阻塞器对腭裂术后腭咽闭合不全 (VPI)的语音功能障碍的治疗作用。方法 :应用腭咽阻塞器治疗腭裂术后VPI患者 13 5例 ,分别于治疗前 ,治疗后 180d、1年、2年 ,观察VPI患者的腭咽闭合不全率 (RVPI)、腭咽闭合不全改善率 (IRVPI)、各单元音共振峰频率F3以及语音效果的变化。结果 :腭咽阻塞器治疗后 ,VPI患者的RVPI逐渐降低 ,IRVPI逐渐增高 ,且各单元音共振峰F3逐渐增高 ,接近正常人 ,与治疗前比较差异有显著性 (P <0 .0 1)。去除阻塞器后 ,45例患者腭咽闭合正常 ,语音恢复正常 ,45例患者腭咽闭合基本正常 ,语音基本正常。结论 :腭咽阻塞器治疗腭咽闭合不全具有恢复语音功能的作用     

腭咽闭合功能障碍诊断和术后语音治疗

良好的腭咽功能在腭裂术后的语音康复中具有决定性作用。因此,腭咽功能的评估成为腭裂序列治疗中的核心环节。腭裂术后腭咽功能构建的完善与否,亦决定着不同的治疗方向。腭咽功能的评估需要综合主观评估、客观评估的结果,评估不仅能够确定腭咽功能完善与否,还能够提供制定手术方案和语言治疗策略的重要信息。腭咽闭合功能障碍术后的语音治疗有其特殊性,但同样使用构音障碍的治疗方法和技术治疗。代偿性构音是特征性的腭裂语音,源于患者对腭咽闭合不全的代偿,是腭咽功能障碍患者语音治疗的重点。     

Velopharyngeal morphology of patients with persistent velopharyngeal incompetence following repushback surgery for cleft palate.

OBJECTIVE: To characterize the velopharyngeal morphology of patients with persistent velopharyngeal incompetence (VPI) following repushback surgery for cleft palate. PARTICIPANTS: Seven patients with moderate to severe VPI following repushback surgery for secondary correction of cleft palate, and 14 patients who had already obtained complete velopharyngeal closure function (VPF) were enrolled. Control data were obtained from the longitudinal files of 20 normal children in Kyushu University Dental Hospital. MAIN OUTCOME MEASURES: Skeletal landmarks and measurements were derived from tracing of lateral roentgenographic cephalograms. The measurements included velar length, pharyngeal depth, and pharyngeal height and the ratio of velar length to pharyngeal depth. Additionally, the configuration of the upper pharynx (pharyngeal triangle) involving the cranial base, cervical vertebrae, and the posterior maxilla and also the position of posterior pharyngeal wall (PPW) in the pharyngeal triangle were analyzed. RESULTS: The VPI group had a significantly shorter velar length and greater pharyngeal depth, resulting in a smaller length/depth ratio than the controls. The points of PPW and cervical vertebrae of the VPI group were located more posteriorly and inferiorly than those in the group with complete VPF after the primary operation and the controls. The positions of cranial base and maxilla were not significantly different. Additionally, the position of PPW in the pharyngeal triangle was located significantly posteriorly and superiorly in the VPI group, compared with the controls. CONCLUSIONS: The craniopharyngeal morphology of patients with persistent VPI was characterized by a short palate, wide-based and counterclockwise-rotated pharyngeal triangle, and posteriorly and superiorly positioned PPW. These might be contributory factors for the prediction of VPF before repushback surgery for cleft palate.     

Comparison of obstructive sleep apnea syndrome in children with cleft palate following Furlow palatoplasty or pharyngeal flap for velopharyngeal insufficiency.

OBJECTIVE: To evaluate the incidence and severity of obstructive sleep apnea syndrome (OSAS) in patients with cleft palate having a Furlow palatoplasty or pharyngeal flap for correction of velopharyngeal insufficiency (VPI). PATIENTS: A total of 48 nonsyndromic children with repaired cleft palate with VPI were enrolled in the study. Twenty of the children had a Furlow palatoplasty (F group) and 28 children had a pharyngeal flap (P group) for correction of VPI. INTERVENTIONS: An overnight polysomnography evaluation was done to evaluate the incidence and severity of OSAS 6 months or more postoperatively. MAIN OUTCOME MEASURES: Symptoms of OSAS, respiratory disturbance index (RDI), oxyhemoglobin desaturation index (DI), and sleep stages were measured. RESULTS: In the P group, the mean percentage of stage 2 sleep was lower than the F group (p <.05). The mean RDI and DI were larger in the P group, compared with the F group (p <.001). The incidence and severity of OSAS were higher in the P group, compared with the F group (p <.001 and p = 0.05, respectively). CONCLUSIONS: A Furlow palatoplasty should be used in deference to a pharyngeal flap whenever possible on the basis of the preoperative evaluation of VPI because of the decreased incidence and severity of OSAS.     

Team acceptance of specific recommendations for the treatment of VPI as provided by speech pathologists

This retrospective study describes the frequency of one team's acceptance of speech pathologists' recommendations for specific secondary treatment procedures for the correction of VPI for 100 consecutive patients. In addition, assessment was made of the level of success in eliminating VPI relative to treatments utilized that were recommended by speech pathologists versus level of success when treatment other than that recommended by speech pathologists were used. For the 78 patients who received the treatment procedure recommended by speech pathologists, only 10 percent continued to demonstrate any clinically significant residual speech problem associated with VPI. However, for the 22 patients who received treatment other than that which had been recommended, 32 percent continued to demonstrate clinically significant speech problems associated with VPI. Data is presented on the success rate for correcting VPI relative to specific treatment recommendations including pharyngeal flap, palatal pushback, pharyngeal wall implant, tonsillectomy, prosthetic palatal lifts, and speech therapy.     

腭咽闭合功能不全语音清晰度评价

目的　研究腭咽闭合功能不全患者的语音清晰度。方法　 10 0例腭咽闭合功能不全患者 ,其中 15例为腭裂 ,2 1例为先天性腭咽闭合不全 ,5 6例为腭裂术后腭咽闭合不全 ,8例为咽成形术后腭咽闭合不全 ,对照组为 32名健康人。 3名语音专业人员共同评价汉语语音清晰度 ,并且分析语音障碍和语音清晰度的关系。结果　健康组的语音清晰度为 99 0 % ,腭咽闭合功能不全组为35 5 % ,其中未手术腭裂组为 19 9% ,先天性腭咽闭合不全为 32 8% ,腭裂术后腭咽闭合不全为4 0 3% ,咽成形术后腭咽闭合不全为 35 2 % ,统计分析显示健康组和病例组各类型之间差异有显著性 (P <0 0 1)。结论　①腭咽闭合功能不全异常语音的语音清晰度差 ,并伴过度鼻音 ;②腭咽闭合不全异常语音中 ,腭裂患者的语音清晰度最低 ,其余依次为先天性腭咽闭合不全、咽成形术后腭咽闭合不全和腭裂术后腭咽闭合不全     

语音辅助器(Speed-Aid)治疗腭咽闭合不全的临床应用研究

目的 探讨S-A治疗腭咽闭合不全（VPI）的临床应用价值。方法 应用纤维鼻咽内窥镜及鼻咽腔造影X线侧位片评价腭咽闭合功能改善程度,应用汉语语音字表评价治疗前后的语音变化,并以鼻咽腔造影X线侧位片来确定咽塞的放置位置。结果13例VPI患者接受S-A治疗,治疗后VPI均得到满意的矫正。结论1.S-A是一种有效矫正VPI的治疗手段;2.S-A治疗后语音有所改善,正常的语音恢复还需进一步的语音治疗。     

腭咽闭合功能生理参数的研究

目的 为区分腭裂术后生理性和病理性腭咽闭合不全，必须提出健康人群生理性ＶＰＩ－这一客观指标。     

Surgical management of velopharyngeal incompetence in velocardiofacial syndrome.

OBJECTIVES: To analyze the results of surgery for velopharyngeal incompetence (VPI) in velocardiofacial syndrome. DESIGN: Prospective data collection, with randomized, blind assessment of speech and velopharyngeal function on lateral videofluoroscopy and nasendoscopy. SETTING: Two-site, tertiary referral cleft unit. PATIENTS: Forty-two consecutive patients with the 22q11 deletion underwent surgery for symptomatic VPI by a single surgeon. INTERVENTIONS: Intraoral examinations, lateral videofluoroscopy (+/- nasendoscopy) and intraoperative evaluation of the position of the velar muscles through the operating microscope. Based on these findings, either a radical dissection and retropositioning of the velar muscles (submucous cleft palate [SMCP repair]) or a Hynes pharyngoplasty (posterior pharyngeal wall augmentation pharyngoplasty) was performed. As anticipated, a proportion of patients undergoing SMCP repair subsequently required a Hynes. The aim of this staged approach was to maximize velar function, thereby enabling a less obstructive pharyngoplasty to be performed. Thus, there were three surgical groups for analysis: SMCP alone, Hynes alone, and SMCP+Hynes. MAIN OUTCOME MEASURES: Blind perceptual rating of resonance and nasal airflow; blind assessment of velopharyngeal function on lateral videofluoroscopy and nasendoscopy; and identification of predictive factors. RESULTS: Significant improvement in hypernasality in all three groups. The SMCP+Hynes group also showed significant improvement in nasal emission. There were significant improvements in the extended and resting velar lengths following SMCP repair and a trend toward increased velocity of closure. CONCLUSIONS: Depending on velopharyngeal anatomy and function, there is a role for SMCP repair, Hynes pharyngoplasty, and a staged combination of SMCP+Hynes, all of which are procedures with a low morbidity.     

Comparison of resonance outcomes after pharyngeal flap and furlow double-opposing z-plasty for surgical management of velopharyngeal incompetence.

OBJECTIVE: The purpose of this study was to test the hypothesis that no significant difference exists in the speech outcomes between patients with severe velopharyngeal incompetence (VPI) who receive a pharyngeal flap and patients with less severe VPI who receive a Z-plasty for management of VPI. DESIGN: This retrospective study from 1993 to 2002 included a review of pre- and postoperative perceptual speech and resonance assessments of patients with marginal VPI who received a Furlow double-opposing Z-plasty and patients with VPI who received a pharyngeal flap. SETTING: All patients had surgical management of VPI at the Cleft Palate-Craniofacial Clinic at University of Iowa Hospitals and Clinics. RESULTS: Both groups benefited from surgery with significant reduction in perceived hypernasality (p < .001). Comparison of postoperative assessments indicated no difference between the groups in hypernasality or hyponasality ratings. Neither group had a significant increase in hyponasality. CONCLUSION: Both pharyngeal flap and double-opposing Z-plasty proved equally effective at reducing hypernasality when the selection of the surgical procedures was based on preoperative ratings of perceived hypernasality and evaluation of velopharyngeal physiology. Severity of the VPI is an important factor when considering surgical management of VPI. Thorough preoperative evaluations of patients with VPI are essential in appropriate treatment planning.     

M期促进因子在唾液腺腺样囊性癌中的表达

目的：研究M期促进因子（MPF）的表达与唾液腺腺样囊性癌（SACC）临床病理特点之间的关系。方法：应用免疫组织化学SP法检测40例SACC组织及40例正常唾液腺组织中MPF的表达。应用Westem印迹测定SACC细胞系SACC-83和SACC肺高转移细胞系SACC-LM中MPF的表达。采用SPSS11．5统计软件包，分别应用χ^2检验、配对t检验和线性相关分析进行统计学处理。结果：SACC组织中MPF的表达明显升高，与正常唾液腺组织之间存在显著差异（P〈0．05）。MPF的表达与SACC的病理类型有关（P〈0．05）。体外培养的SACC细胞系SACC-LM中MPF的表达显著高于SACC-83中MPF的表达（P〈0．05）。结论：MPF在SACC组织中呈高表达，其表达与SACC的发生密切相关，MPF的异常激活是SACC恶性增殖的原因之一，MPF与SACC的转移能力有关。