成人继发性唇裂修复术：手术模式与探索性患者报告结局

文献信息

中文摘要

背景： 尽管儿童期已行修复，残余唇裂畸形仍可能持续至成年，并造成美学、功能及心理社会方面的困扰。接受孤立性唇裂修复术的成人仍鲜有报道。本研究旨在描述孤立性继发性唇裂修复术后的手术模式、患者动机、临床结局及探索性患者报告结局趋势。
方法： 对2020年至2024年间在两家三级颅面中心接受孤立性继发性唇裂修复术的成人进行回顾性队列研究。排除同期接受鼻成形术或其他唇裂手术的患者。回顾性审查人口学、手术、临床及患者报告结局数据。由于随访时间及问卷完成情况非标准化，PROM分析仅限于配对应答者。
结果： 108名成人接受了孤立性唇裂修复术（平均年龄22.8岁）。瘢痕切除术占80.6%，口轮匝肌重建术占59.3%，人中重建术占47.2%，唇红修复术占35.2%。教育、职业或婚姻过渡方面的顾虑是最常见的修复动机（41%）。未发生需要住院或再次手术的并发症。31%的患者仍存在残余不规则，最常见为唇红切迹和增生性瘢痕形成。在配对PROM应答者中，术后评分在心理社会及外观相关领域普遍较高，但解释受限于随访不完整及评估间隔非标准化。
结论： 成人继发性唇裂修复术常需联合重建瘢痕、肌肉、唇红及人中畸形。由于重建操作常联合进行，无法确定特定技术对结局的影响。在有纵向随访数据的患者中，术后PROM评分在心理社会及外观相关领域普遍较高。

英文摘要

BACKGROUND: Residual cleft lip deformities may persist into adulthood despite childhood repair and contribute to aesthetic, functional, and psychosocial concerns. Adults undergoing isolated cleft lip revision remain underreported. This study characterized operative patterns, patient motivations, clinical outcomes, and exploratory patient-reported outcome trends after isolated secondary cleft lip revision.
METHODS: A retrospective cohort study was performed of adults undergoing isolated secondary cleft lip revision between 2020 and 2024 at two tertiary craniofacial centers. Patients undergoing concomitant rhinoplasty or other cleft procedures were excluded. Demographic, operative, clinical, and patient-reported outcome data were reviewed retrospectively. PROM analyses were limited to paired responders because follow-up timing and questionnaire completion were nonstandardized.
RESULTS: One hundred eight adults underwent isolated cleft lip revision (mean age, 22.8 years). Scar excision was performed in 80.6%, orbicularis reconstruction in 59.3%, philtral reconstruction in 47.2%, and vermilion revision in 35.2%. Educational, occupational, or marital transition concerns were the most common motivation for revision (41%). No complications requiring hospital admission or reoperation occurred. Residual irregularities remained present in 31% of patients, most commonly vermilion notching and hypertrophic scar formation. Among paired PROM responders, postoperative scores were generally higher across psychosocial and appearance-related domains, although interpretation is limited by incomplete follow-up and nonstandardized assessment intervals.
CONCLUSIONS: Adult secondary cleft lip revision often required combined reconstruction of scar, muscular, vermilion, and philtral deformities. Because reconstructive maneuvers were commonly combined, technique-specific outcome effects could not be determined. Among patients with available longitudinal follow-up, postoperative PROM scores were generally higher across psychosocial and appearance-related domains.