咽后壁组织瓣转移术后渗血的原因分析和处理

doi:10.19438/j.cjoms.2019.02.015

中国口腔颌面外科杂志 ›› 2019, Vol. 17 ›› Issue (2): 171-174.doi: 10.19438/j.cjoms.2019.02.015

咽后壁组织瓣转移术后渗血的原因分析和处理

吴忆来, 王国民, 杨育生, 万腾, 陈阳, 梁赟

上海交通大学医学院附属第九人民医院·口腔医学院口腔颅颌面科,国家口腔疾病临床医学研究中心, 上海市口腔医学重点实验室,上海市口腔医学研究所,上海 200011

收稿日期:2018-09-21 修回日期:2018-12-12 出版日期:2019-03-20 发布日期:2019-04-12
通讯作者: 杨育生, E-mail：yysdj4829@163.com
作者简介:吴忆来（1976-）,女,博士,主治医师,E-mail：fuyu_mi@163.com
基金资助:
上海市科学技术委员会资助项目(08DZ2271100)

Analysis of postoperative bleeding after pharyngoplasty with posterior pharyngeal flap

WU Yi-lai, WANG Guo-min, YANG Yu-sheng, WAN Teng, CHEN Yang, LIANG Yun

Department of Oral and Craniomaxillofacial Surgery,Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. Shanghai 200011, China

Received:2018-09-21 Revised:2018-12-12 Online:2019-03-20 Published:2019-04-12

摘要/Abstract

摘要： 目的:针对咽后壁组织瓣转移术后出血的部位及原因,分析探讨手术技巧及渗血处理对策。方法:对2003年1月—2017年12月间在上海交通大学医学院唇腭裂治疗研究中心接受咽后壁组织瓣转移术且围术期出现术区渗血的患者,根据其探查止血记录,总结渗血部位、原因及处理方法。结果:15年间,接受咽后壁组织瓣转移术的患者共1141例,术后出现伤口明显渗血9例（0.79%）,均返手术室在全麻下探查止血;出血部位分别为软腭部4例（44.5%）、咽瓣蒂部2例（22.2%）、鼻咽部3例（33.3%）,经缝扎和电凝后控制。结论:咽后壁组织瓣转移术中尤其要注意软腭部血管的保护,蒂部血管的处理,勿损伤鼻咽部黏膜。一旦术后发生渗血,较为凶险,一般需立即返手术室在全麻下探查止血。

关键词: 腭裂, 咽后壁组织瓣转移术, 出血

Abstract: PURPOSE: The aim of this study was to analyse the location and cause of postoperative bleeding after posterior pharyngeal flap surgery and to investigate the surgical techniques for managing bleeding. METHODS: Patients who received pharyngoplasty with posterior pharyngeal flap in the Cleft Lip and Palate Treatment and Research Centre of Shanghai Jiao Tong University School of Medicine from January 2003 to December 2017 were reviewed, and postoperative bleeding in the surgical area was retrospectively analyzed. RESULTS: During 15 year's study, a total of 1141 patients received posterior pharyngeal flap pharyngoplasty. Among them, nine(0.79%) experienced significant postoperative bleeding with exploration of haemostasis. They were sent back to the operating room for exploration of bleeding under general anaesthesia. The sites of bleeding included 4 cases (44.5%) in the soft palate, 2 cases (22.2%) in the pharyngeal flap pedicle, and 3 cases (33.3%) in the nasopharynx. CONCLUSIONS: During posterior pharyngeal flap pharyngoplasty, particular attention should be paid to protection of blood vessels in the soft palate and handling of the vascular pedicle. Postoperative bleeding is very dangerous and generally requires immediate exploration in the operating room under general anaesthesia.

Key words: Cleft palate, Posterior pharyngeal flap pharyngoplasty, Bleeding

中图分类号:

R782.2

吴忆来, 王国民, 杨育生, 万腾, 陈阳, 梁赟. 咽后壁组织瓣转移术后渗血的原因分析和处理[J]. 中国口腔颌面外科杂志, 2019, 17(2): 171-174.

WU Yi-lai, WANG Guo-min, YANG Yu-sheng, WAN Teng, CHEN Yang, LIANG Yun. Analysis of postoperative bleeding after pharyngoplasty with posterior pharyngeal flap[J]. China J Oral Maxillofac Surg, 2019, 17(2): 171-174.

参考文献

[1] Paulson LM, Macarthur CJ, Beaulieu KB, et al.Speech outcomes after tonsillectomy in patients with known velopharyngeal insufficiency[J]. Int J Otolaryngol, 2012, 2012: 912767.
[2] Hofer SO, Dhar BK, Robinson PH, et al.A 10-year review of perioperative complications in pharyngeal flap surgery[J]. Plast Reconstr Surg, 2002, 110(6): 1393-1397.
[3] Hogan VM.A clarification of the surgical goals in cleft palate speech and the introduction of the lateral port control (l.p.c.) pharyngeal flap[J]. Cleft Palate J, 1973, 10: 331-345.
[4] Shprintzen RJ, Lewin ML, Croft CB, et al.A comprehensive study of pharyngeal flap surgery: tailor made flaps[J]. Cleft Palate J, 1979, 16(1): 46-55.
[5] 王国民, 杨育生, 陈阳, 等. 改良咽后壁组织瓣转移术治疗腭咽闭合功能不全[J]. 中华耳鼻咽喉科杂志, 2004, 39(4): 200-203.
[6] Canady JW, Cable BB, Karnell MP, et al.Pharyngeal flap surgery: protocols, complications, and outcomes at the University of Iowa[J]. Otolaryngol Head Neck Surg, 2003, 129(4): 321-326.
[7] Crockett DJ, Goudy SL.Update on surgery for velopharyngeal dysfunction[J]. Curr Opin Otolaryngol Head Neck Surg, 2014, 22(4): 267-275.
[8] de Serres LM, Deleyiannis FW, Eblen LE, et al. Results with sphincter pharyngoplasty and pharyngeal flap[J]. Int J Pediatr Otorhinolaryngol, 1999, 48(1): 17-25.
[9] Woo AS.Velopharyngeal dysfunction[J]. Semin Plast Surg, 2012, 26(4): 170-177.
[10] Sloan GM.Posterior pharyngeal flap and sphincter pharyngoplasty: the state of the art[J]. Cleft Palate Craniofac J, 2000, 37(2): 112-122.
[11] Vandevoort MJ, Mercer NS, Albery EH.Superiorly based flap pharyngoplasty: the degree of postoperative "tubing" and its effect on speech[J]. Br J Plast Surg, 2001, 54(3): 192-196.
[12] 王国民, 杨育生. 唇腭裂序列治疗 [M]. 杭州: 浙江科学技术出版社, 2014: 220-229.
[13] Fraulin FO, Valnicek SM, Zuker RM.Decreasing the perioperative complications associated with the superior pharyngeal flap operation[J]. Plast Reconstr Surg, 1998, 102(1): 10-18.
[14] Valnicek SM, Zuker RM, Halpern LM, et al.Perioperative complications of superior pharyngeal flap surgery in children[J]. Plast Reconstr Surg, 1994, 93(5): 954-958.
[15] Cole P, Banerji S, Hollier L, et al.Two hundred twenty-two consecutive pharyngeal flaps: an analysis of postoperative complications[J]. J Oral Maxillofac Surg, 2008, 66(4): 745-748.
[16] 程宁新, 张奎启, 宋儒耀. 软腭动脉血供的应用解剖学研究[J]. 中华整形外科杂志, 2000, 16(4): 208-211.
[17] 张奎启, 王治熙, 尹晓青, 等. 健康人和唇腭裂者上唇和腭的动脉供应[J]. 中华口腔医学杂志, 1994, 29(1): 30-33.

咽后壁组织瓣转移术后渗血的原因分析和处理

Analysis of postoperative bleeding after pharyngoplasty with posterior pharyngeal flap

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	闫婷婷, 张鹏, 韩合理, 王荷静, 王奇民, 陈行, 袁荣涛. 腭静脉畸形合并遗传性出血性毛细血管扩张症1例报告[J]. 中国口腔颌面外科杂志, 2023, 21(6): 626-629.
[2]	王建荣, 孙静, 赵树红, 尚将. 下颌第三磨牙拔除术后出血风险模型的构建[J]. 中国口腔颌面外科杂志, 2023, 21(5): 479-485.
[3]	高涛, 马莲, 罗奕, 孙勇刚. 鼻音计鼻音化率值与腭咽闭合状态关系的探讨[J]. 中国口腔颌面外科杂志, 2023, 21(4): 372-376.
[4]	蓝春慧, 张雪燕, 韦敏玲, 丁文炜, 梁建华. 整体性护理路径在先天性腭裂患儿手术护理中的应用[J]. 中国口腔颌面外科杂志, 2023, 21(3): 237-242.
[5]	曹爽, 康华, 陈洁. 纤维支气管镜引导对经鼻腔气管插管患者术后拔管时鼻出血的影响[J]. 中国口腔颌面外科杂志, 2023, 21(3): 253-257.
[6]	代晓彤, 张敬玲, 李珍, 马嫣然, 刘思宇, 徐晓雨, 卢恕来. 甲状舌管囊肿合并遗传性凝血因子V缺乏症1例报告[J]. 中国口腔颌面外科杂志, 2022, 20(4): 410-412.
[7]	褚珺, 胡明, 王国民, 吕挺正. 19例合并凝血功能异常的腭裂患儿围术期处理[J]. 中国口腔颌面外科杂志, 2022, 20(3): 282-286.
[8]	郝新河, 高超, 沈末伦, 叶虎, 赵君, 储德强, 翟沁凯. 术前继续口服抗凝药对复杂牙拔除术后出血的影响[J]. 中国口腔颌面外科杂志, 2021, 19(3): 226-229.
[9]	张凌, 仇琳, 纪均. 喷他佐辛预防儿童腭裂手术全麻苏醒期躁动的效果评价[J]. 中国口腔颌面外科杂志, 2021, 19(1): 40-44.
[10]	林晓锐, 李晨曦, 张秀华. 瑞芬太尼复合氯胺酮在婴幼儿唇腭裂手术中的麻醉效果分析[J]. 中国口腔颌面外科杂志, 2021, 19(1): 45-48.
[11]	赵欣然, 蔡鸣. 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[J]. 中国口腔颌面外科杂志, 2021, 19(1): 76-81.
[12]	牟思璇, 朱妍菲, 杜常欣, 王雪纯, 吴艳棋, 梅鹏, 王旭东, 朱敏. 改良牙支持式上颌骨前部牵引成骨术与上颌骨Le Fort I型前徙术对唇腭裂患者腭咽部结构的影响[J]. 中国口腔颌面外科杂志, 2020, 18(5): 427-433.
[13]	张晓敏, 杨雅娴, 宗源, 林鸣. Noordhoff手术联合PNAM正畸治疗唇腭裂患儿的疗效评价[J]. 中国口腔颌面外科杂志, 2020, 18(4): 352-356.
[14]	张文静, 王霞. 非综合征唇裂伴或不伴腭裂对口腔健康相关生活质量的影响[J]. 中国口腔颌面外科杂志, 2020, 18(3): 255-259.
[15]	姚志涛, 安玮, 买买提吐逊·吐尔地. 50例唇腭裂患儿手术前、后血液生化指标及腭裂隙内骨再生评价[J]. 中国口腔颌面外科杂志, 2020, 18(1): 56-59.