Comparison of Pharyngeal Flap and Sphincter Pharyngoplasty for Velopharyngeal Insufficiency-A Retrospective Study

咽瓣和括約式咽部成形術應用在顎咽閉鎖不全之比較：回溯性研究

林敬鈞(Ching-Chun Lin) ； 羅綸洲(Lun-Jou Lo)

《中華民國整形外科醫學會雜誌》 17卷3期 (2008/09) Pp. 224-231

https://doi.org/10.7096/JPSA.200809.0224

摘要

顎咽閉鎖不全是顎咽括約肌的不完全閉鎖，在發聲時會造成鼻音並且會造成語言的可理解性下降。在之前長庚紀念醫院顱顏中心的治療計畫中，咽瓣或括約式咽部成形術都被認為適合用來治療中度至重度顎咽閉鎖不全的病人。因此這篇文張的目的就是要比較咽瓣和括約式咽部成形術的語言成效和呼吸道併發症的發生比率之間的差異性。
從1995年6月至2001年8月之間，87個接受過咽瓣和括約式咽部成形術的病人中有71位被列入這個研究。整體的追蹤期間則是從1996年6月到2006年10月。所有的手術都是由同一位醫師完成的。
整體的語言成效及手術成功率是68%。語言成效在咽瓣和括約式咽部成形術之間並沒有顯著的差異(chi-square test, p=0.419)。整體的呼吸道併發症的比率是14%。呼吸道併發症的比率在咽瓣和括約式咽部成形術之間則是有顯著差異的(chi-square test, p=0.015)。此外，手術年齡小於6歲的病人的語言成效顯著地優於手術年齡大於6歲的病人(chi-square test, p=0.026)。
所以結論是，在現在長庚紀念醫院顱顏中心裡，Furlow's術式被用來治療輕度的顎咽閉鎖不全而咽瓣則是適合用來治療中度至重度顎咽閉鎖不全的病人。而病人在6歲之前手術則可以達到顯著較佳的語言成效。

並列摘要

Purpose: Velopharyngeal insufficiency (VPI) is incomplete closure of the velopharyngeal space causing hypernasal resonance during phonation. Both pharyngeal flap (PF) and sphincter pharyngoplasty (SP) had been used for the correction of VPI in the Craniofacial Center, Chang Gung Memorial Hospital. The purpose of this study is to compare the effectiveness and complication between the PF and SP.
Material and Method: Eighty-seven patients underwent pharyngeal flap or sphincter pharyngoplasty for VPI between June of 1995 and August of 2001. Seventy-one patients of them who had complete preoperative and follow-up evaluations were included. The follow-up period ended at October of 2006. All operations were done by one surgeon. Standard speech evaluation was performed.
Results: Overall speech outcome and success rate was 68%. No significant difference on the speech outcome was found between the PF group and SP groups (chi-square test, p=0.419). Overall nasal airway obstruction rate was 14%. However, a significant difference on airway obstruction was noted between the PF group and SP group (chi-square test, p=0.015). Lower incidence of airway obstruction occurred in PF group. A concomitant finding revealed that a better speech result was achieved in patients who received the VPI surgery at an age younger than 6 years.
Conclusion: This study showed that, in the authors' center, the PF is a better choice than SP for the correction of VPI.

並列關鍵字

pharyngeal flap ； sphincter pharyngoplasty ； velopharyngel insufficiency