改良Millard术式对双侧完全性唇裂患儿鼻唇畸形的修复效果研究

    王慧敏 张文静

    

    

    [摘要]目的:探究改良Millard术式对双侧完全性唇裂患儿鼻唇畸形的修复效果。方法:将42例双侧完全性唇裂患儿作为观察组,使用改良Millard术式进行治疗;同时收集同年龄段体检正常的42例儿童作为对照组。术后24个月,比较两组研究对象的唇高、唇长、鼻底宽度、鼻小柱高度及家属心理状态。结果:术后,观察组两侧唇高均降低、唇长增加、鼻底宽度缩短、鼻小柱高度增加,差异均具有统计学意义(P0.05),但两组间唇高、鼻小柱高度比较具有统计学差异(P<0.05)。术后与术前比较,患儿家属的精神病性、躯体化、偏执、强迫症、恐怖、人际关系、敌对症、焦虑评分均降低,差异均具有统计学意义(P<0.05)。结论:改良Millard术式对双侧完全性唇裂患儿鼻唇畸形可有效复位、重建鼻唇部解剖亚单位,同时降低家属心理负担,值得临床推广应用。

    [关键词]改良Millard术;双侧完全性唇裂;症状自评量表;解剖亚单位;口轮匝肌

    [中图分类号]R782.2+1 ? ?[文献标志码]A ? ?[文章编号]1008-6455(2020)05-0052-03

    Abstract: Objective ? To explore the repair of deformity of nose and lip in children with bilateral complete cleft lip by using modified Millard procedure. Methods ?42 children with bilateral complete cleft lip were collected as the observation group, and 42 children with normal physical examination were collected as control group. The observation group was treated with modified Millard procedure. The height of lip, length of lip, width of nasal floor, height of nasal column and psychological status of family members were compared between the two group. 24 months after operation, the psychological state of the family members in the observation group was compared before and after treatment. Results ? Compared with pre-operation, the lip height of both sides decreased, the length of lip increased, the width of nasal floor shortened and the height of nasal column increased in the observation group (P0.05), but there were significant differences in lip height and nasal column height between the two groups (P<0.05). After operation, the scores of psychosis, somatization, paranoid ideation, obsessive-compulsive disorder, phobia, interpersonal relationship, hostility and anxiety of children's family in the observation group were significantly lower than those before operation (P<0.05). Conclusion ? The modified Millard procedure is effective in the repair of deformity of nose and lip in children with bilateral cleft lip. It can be used to reconstruct the anatomic subunits of nasal lip and reduce the psychological burden of family members, which is worthy for clinical promotion.

    Key words: modified Millard procedure; bilateral complete cleft lip; symptom checklist; anatomical sub-unit; oral-wheel-turn muscle

    唇裂是胚胎发育异常导致的颅面部先天性畸形之一,发生率位居颅面部先天性畸形的第一位,双侧完全性唇裂表现为人中嵴结构消失、前唇组织量异常、鼻小柱短小等多个鼻唇部亚单位的异位及缺失,修复难度大且对患者及家属造成渐进性的精神伤害。因此多在患儿年龄较小时采用手术的方式进行治疗,随着临床研究的深入,其治疗原则也由单纯封闭上唇裂隙转变为对鼻唇部相关解剖亚单位的复位、重建[1-3]。双側唇裂主要修复方式包括Barsky 法、Millard手术及Cutting 法,其中改良Millard术式进一步松解了口周的口轮匝肌及鼻翼软骨,效果更佳[4]。目前改良Millard术式在单侧唇裂患儿的应用研究较多[5-6],而在双侧完全性唇裂中的应用较为少见,缺乏相关临床依据。本研究对笔者科室42例接受改良Millard术式治疗的双侧完全性唇裂患儿进行研究,旨在探究改良Millard术式对双侧完全性唇裂患儿鼻唇畸形的修复效果,现将结果报道如下。

    双侧完全性唇裂畸形本身以及社会反应等均会影响唇裂患儿心理发育,更给家庭带来沉重的精神与照顾负担,随着治疗技术及理念的不断发展,先天性疾病患儿家属心理状态在临床上受到越来越多的关注。母亲在唇裂患儿的信息传递和交流中占据重要地位,且受到患儿畸形困扰程度更深[19],因此,本研究对患儿母亲的心理状况进行分析,以判断患儿家属心理状况。既往研究结果表明单侧唇裂患儿家属存在焦虑、抑郁程度高,生活质量差的情况[20]。本研究结果表明术后观察组患儿家长SCL-90评分各指标得分,包括精神病性、躯体化、偏执、强迫症、恐怖、人际关系、敌对症及焦虑评分均降低,差异均具有统计学意义。说明观察组接受改良Millard术治疗后,通过面部肌肉的复位、前部及侧唇的黏膜瓣的利用,口鼻面部结构缺损、位移有了较大程度的改善,降低了患儿家属对患儿面貌畸形的担忧及其负性心理。同时,改良Millard术作为1次手术治疗双侧完全性唇裂畸形的治疗方式,简化了复杂的唇腭裂序列治疗,减少了治疗的时间,进而降低家属治疗负担,可减轻其心理障碍[17]。

    综上,改良Millard术式对双侧完全性唇裂患儿鼻唇畸形可有效复位、重建鼻唇部解剖亚单位,同时降低家属心理负担。

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    [收稿日期]2019-10-14

    本文引用格式:王慧敏,张文静.改良Millard术式对双侧完全性唇裂患儿鼻唇畸形的修复效果研究[J].中国美容医学,2020,29(5):52-55.