不同病因所致腭咽闭合不全中咽后壁脂肪注射增强术的短期疗效

文献信息

中文摘要

引言： 咽后壁脂肪注射增强已成为改善腭咽结构的一种新兴方法。本研究旨在评估不同体积脂肪注射增强咽后壁对III至IV级腭咽瓣（VPV）闭合的腭咽闭合不全（VPI）患者改善腭咽瓣（VPV）功能的短期疗效。
方法： 前瞻性观察性病例系列研究，纳入24例年龄4至24岁的患者，表现为继发于腭裂、黏膜下腭裂或腺样体切除术后的持续性腭咽闭合不全（VPI）。经口将自体脂肪注射至咽后壁黏膜下层，体积从最小5 cc至最大15 cc不等。
结果： 本研究表明，脂肪增强显著改善了腭咽闭合、听觉感知评估（APA）中所有强制性言语错误参数及言语不清程度，以及腭帆活动度。术后静息时及发声时软腭与咽后壁之间的间隙测量均显著减小。大多数患者报告脂肪采集区和颈部轻度不适，无重大并发症。
结论： 咽后壁脂肪增强是一种安全且耐受良好的手术，可改善III-IV级VPV闭合的VPI患者的腭咽功能，因使用自体组织而并发症极少。

英文摘要

INTRODUCTION: Fat injection for posterior pharyngeal wall augmentation has become an emerging method of enhancing velopharyngeal structures. This study aimed to evaluate the short-term outcomes of fat injection in the enhancement of the posterior pharyngeal wall with different volumes in improving velopharyngeal valve (VPV) function in velopharyngeal insufficiency (VPI) patients with grade III to IV VPV closure.
METHODS: Observational prospective case series of 24 patients, aged 4 to 24 years, presenting with persistent velopharyngeal insufficiency (VPI) secondary to cleft palate, submucous cleft palate, or post-adenoidectomy. Autologous fat was injected trans orally into the submucosal layer of the posterior pharyngeal wall, varying from a minimum of 5 cc to a maximum of 15 cc.
RESULTS: The present study demonstrated that fat augmentation significantly improved velopharyngeal closure, auditory perceptual assessment "APA" parameters regarding all obligatory speech errors and the degree of speech unintelligibility, and velar mobility. Significant reduction was demonstrated in the gap measurements between the soft palate and posterior pharyngeal wall at both rest and during phonation post-operatively. Most patients reported mild discomfort in the area of fat harvesting and the neck, with no major complications.
CONCLUSION: Fat augmentation of the posterior pharyngeal wall was a safe and well-tolerated procedure for enhancing velopharyngeal function in VPI patients with grade III-IV VPV closure, with minimal complications due to autologous tissue application.