腭裂患儿在日间手术与传统住院模式下术后并发症的影响因素分析

doi:10.19438/j.cjoms.2026.04.010

摘要/Abstract

摘要： 目的：探讨腭裂手术日间模式和传统住院模式下术后并发症发生的风险因素差异。方法：选择2017年1月—2024年8月于上海交通大学医学院附属第九人民医院口腔颅颌面科行一期腭裂修复术的腭裂患儿3 040例,根据住院模式不同分为日间手术组（日间组,n=453）和病房手术组（病房组,n=2 587）,比较两组基线资料、围术期指标、术后并发症发生率,并通过倾向性评分匹配、多因素回归分析两组并发症危险因素差异。结果：日间组的术后并发症发生率显著高于病房组（17.7%∶13.1%,P<0.05）,但其住院时间及治疗费用均显著低于病房组（P<0.05）。倾向匹配后日间组的术后并发症发生率略高于病房组（17.7%∶12.8%）,但差异无统计学意义（校正后P=0.077）。校正性别、月龄、身体质量指数、ASA 分级后亚组分析表明,病房组术后并发症与腭裂分型（2型、3型）及术前合并症显著相关（P<0.05）,且与术前合并症存在显著交互作用（P<0.05）;而日间组上述因素与并发症风险无显著关联（P>0.05）。结论：腭裂日间手术可显著缩短住院时间、降低医疗费用,其术后并发症发生率略高于传统住院模式,且与传统住院模式的术后并发症风险因素（腭裂分型和术前合并症）无显著关联,临床上需针对性加强日间手术术后并发症监测与防控。

关键词: 腭裂修复, 日间手术, 传统住院模式, 术后并发症, 影响因素

Abstract: PURPOSE: To compare the risk factors of postoperative complications between the day surgery and traditional inpatient models of cleft palate surgery. METHODS: A total of 3 040 patients who received one-stage cleft palate repair in the Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital from January 2017 to August 2024 were selected and divided into the day-surgery group (n=453) and the inpatient-surgery group (n=2 587) according to different hospitalization modes. Baseline characteristics, perioperative parameters, and postoperative complication rates were compared between the two groups. Additionally, propensity score matching and multivariate regression analysis were employed to identify differences in risk factors for complications between the two groups. RESULTS: In the primary analysis, the incidence of postoperative complications in the day-surgery group was significantly higher than that in the inpatient-surgery group (17.7% vs 13.1%, P<0.05). However, both the length of hospital stay and treatment costs were significantly lower in the day-surgery group compared to the inpatient-surgery group (P<0.05). After propensity score matching, the incidence of postoperative complications in the day- surgery group was slightly higher than that in the inpatient-surgery group (17.7% vs 12.8%), but this difference did not reach statistical significance (adjusted P=0.077). Subgroup analysis after adjusting for gender, age in months, body mass index, and ASA classification showed that postoperative complications in the inpatient-surgery group were significantly associated with cleft palate type (types 2 and 3) and preoperative comorbidities (P<0.05), with significant interaction effects of preoperative comorbidities (P<0.05). In contrast, no significant associations were found between these factors and complication risk in the day-surgery group (P>0.05). CONCLUSIONS: Cleft palate day surgery can significantly shorten hospital stays and reduce medical costs. The postoperative complication rate is slightly higher than that of the traditional inpatient model, and there is no significant correlation with the postoperative complication risk factors of the traditional inpatient model (cleft palate classification and preoperative comorbidities). Clinically, it is necessary to strengthen monitoring and prevention of postoperative complications after day surgery in a targeted manner.

Key words: Cleft palate repair, Day surgery, Traditional hospitalization mode, Postoperative complications, Risk factors

中图分类号:

R782.2

陶洁, 王惠琳, 蔡鸣, 李静洁, 董翔. 腭裂患儿在日间手术与传统住院模式下术后并发症的影响因素分析[J]. 中国口腔颌面外科杂志, 2026, 24(4): 382-388.

Tao Jie, Wang Huilin, Cai Ming, Li Jingjie, Dong Xiang. Differences in risk factors of postoperative complications in cleft palate surgery between day surgery and traditional hospitalization mode[J]. China J Oral Maxillofac Surg, 2026, 24(4): 382-388.

参考文献

[1] Babai A, Irving M.Orofacial clefts: genetics of cleft lip and palate[J]. Genes (Basel), 2023, 14(8): 1603.
[2] Yılmaz HN, Özbilen EÖ, Ustün T.The prevalence of cleft lip and palate patients: a single-center experience for 17 years[J]. Turk J Orthod, 2019, 32(3): 139-144.
[3] Salari N, Darvishi N, Heydari M, et al.Global prevalence of cleft palate, cleft lip and cleft palate and lip: a comprehensive systematic review and meta-analysis[J]. J Stomatol Oral Maxillofac Surg, 2022, 123(2): 110-120.
[4] 李承浩, 安阳, 段小红, 等. 先天口面裂的分级分类诊疗专家共识[J]. 华西口腔医学杂志, 2025, 43(1): 1-14.
Li CH, An Y, Duan XH, et al.Expert consensus on classification and diagnosis of congenital orofacial cleft[J]. West China Journal of Stomatology, 2025, 43(1): 1-14.
[5] Hardcastle T.Anaesthesia for repair of cleft lip and palate[J]. J Perioper Pract, 2009, 19(1): 20-23.
[6] 胡广伟, 廖天安, 王涛, 等. 腭裂术后松弛切口不同处理方法的疗效对比研究[J]. 中国现代医学杂志, 2018, 28(2): 93-97.
Hu GW, Liao TA, Wang T, et al.Different management of relaxed incision in cleft palate surgery[J]. China Journal of Modern Medicine, 2018, 28(2): 93-97.
[7] 吴萍丽. 小儿唇腭裂修复术后麻醉苏醒期并发症护理体会[J]. 实用临床护理学电子杂志, 2016, 1(5): 127, 130.
Wu PL. Experience in nursing management of complications during anesthesia recovery period after pediatric cleft lip and palate repair surgery [J]. Practical Clinical Nursing Electronic Journal, 2016, 1(5): 127, 130.
[8] Martin SV, Reed B, Fallico N.Patient safety and suitability for primary cleft lip repair as day case surgery-a systematic review and meta-analysis[J]. Cleft Palate Craniofac J, 2025, 62(1): 97-107.
[9] Jain NS, Cronin BJ, Liu MT, et al.The implications of same-day discharge after primary unilateral cleft lip repair: a national surgical quality improvement program-based study[J]. J Craniofac Surg, 2022, 33(2): 436-439.
[10] Santos M, García J, Graf S, et al.Protocol for outpatient management in cleft lip and palate repair[J]. Int J Pediatr Otorhinolaryngol, 2021, 142: 110592.
[11] Kantar RS, Cammarata MJ, Rifkin WJ, et al.Outpatient versus inpatient primary cleft lip and palate surgery: analysis of early complications[J]. Plast Reconstr Surg, 2018, 141(5): 697e-706e.
[12] Fitz-Henry J.The ASA classification and peri-operative risk[J]. Ann R Coll Surg Engl, 2011, 93(3): 185-187.
[13] 孟庆冰, 景建龙. 南京地区单纯腭裂患儿术后并发症的影响因素分析[J]. 中国美容医学, 2021, 30(8): 150-153.
Meng QB, Jing JL.Analysis of influencing factors of postoperative complications in children with cleft palate in Nanjing Area[J]. Chinese Journal of Aesthetic Medicine, 2021, 30(8): 150-153.
[14] 黄秀拉, 胡园园, 李锋. 唇腭裂患儿术后并发症发生的影响因素分析[J]. 护理与康复, 2020, 19(2): 25-27.
Huang XL, Hu YY, Li F.Analysis on influencing factors of postoperative complications for children with cleft lip and palate[J]. Journal of Nursing and Rehabilitation, 2020, 19(2): 25-27.
[15] 宋丽, 袁维秀, 米卫东, 等. 围术期潜在困难气道的识别与处理[J]. 临床麻醉学杂志, 2015, 31(6): 616-618.
Song L, Yuan WX, Mi WD, et al.Identification and management of potential difficult airways during the perioperative period[J]. Journal of Clinical Anesthesiology, 2015, 31(6): 616-618.
[16] 周炼, 马莲, 刘瑞昌, 等. Pierre Robin综合征低龄患者行腭裂修复术围手术期的风险评价[J]. 中华口腔医学杂志, 2004, 39(5): 356-358.
Zhou L, Ma L, Liu RC, et al.Perioperative risk factors evaluation of cleft palate repair in Pierre Robin sequence at early age[J]. Chinese Journal of Stomatology, 2004, 39(5): 356-358.
[17] 刘克英. 腭裂手术麻醉困难气管内插管的术前评估[J]. 中国实用口腔科杂志, 2009, 2(6): 329-333.
Liu KY.Preoperative evaluation of difficult endotracheal intubation for cleft palate patients[J]. Chinese Journal of Practical Stomatology, 2009, 2(6): 329-333.
[18] Rajan S, Kurien M, Gupta AK, et al.Velopharyngeal incompetence in patients with cleft palate, flexible video pharyngoscopy and perceptual speech assessment: a correlational pilot study[J]. J Laryngol Otol, 2014, 128(11): 986-990.