Hiệu quả phẫu thuật tạo hình thành hầu biến đổi trong điều trị bệnh nhân khe hở vòm miệng có thiểu năng vòm - hầu=Effect of modified pharyngoplasty in the treatment of cleft palate patients with velopharyngeal insufficiency

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Hoài Phương Lâm, Việt Anh Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.110-117

Bộ sưu tập: Metadata

ID: 243676

Thêm vào giỏ

Thiểu năng vòm - hầu là bệnh lý thường gặp trên bệnh nhân khe hở vòm miệng sau phẫu thuật đóng khe hở thì đầu, khiến bệnh nhân gặp những vấn đề về phát âm, ảnh hưởng đến chất lượng cuộc sống. Phẫu thuật tạo hình thành hầu giúp sửa chữa, khôi phục lại khiếm khuyết về giải phẫu còn gặp phải trên bệnh nhân khe hở vòm miệng, tuy nhiên tại Việt Nam chưa nhiều nghiên cứu đánh giá về hiệu quả của phẫu thuật này. Mục tiêu: Mô tả đặc điểm lâm sàng bệnh nhân khe hở vòm miệng có thiểu năng vòm - hầu và đánh giá sự cải thiện phát âm, lành thương và thay đổi về cấu trúc giải phẫu qua hình ảnh nội soi sau phẫu thuật tạo hình thành hầu trên nhóm bệnh nhân này. Đối tượng và phương pháp: Phương pháp nghiên cứu là loạt ca lâm sàng, tiến cứu trên 40 bệnh nhân khe hở vòm miệng được chẩn đoán thiểu năng vòm - hầu, phẫu thuật tại Bệnh viện Chuyên khoa Răng Hàm Mặt - Tạo hình Mỹ Thiện từ tháng 12/2022 đến tháng 12/2023. Kết quả: Nghiên cứu được thực hiện trên 40 bệnh nhân với tuổi trung bình là 16,8 ± 8,62, nam giới chiếm tỉ lệ 39% và nữ giới chiếm 61%. 100% bệnh nhân trước phẫu thuật có thoát khí mũi và rối loạn cộng hưởng âm. Sau phẫu thuật 6 tháng, điểm số rối loạn phát âm giảm 2,63 ± 1,13 (50,1%) so với trước phẫu thuật (p <
0,05). Sau phẫu thuật 1 tuần, 73,3% trường hợp lành thương tốt, 26,7% lành thương trung bình
sau 1 tháng, tất cả trường hợp đều đạt lành thương tốt. Tỉ số đóng kín vòm - hầu (VCR) khi quan sát trên nội soi tăng 15,6% sau phẫu thuật. Kết luận: Phẫu thuật giúp cải thiện rõ rệt khả năng phát âm của bệnh nhân trên hai tiêu chí: giảm giọng mũi và giảm thoát khí qua mũi khi nói
giúp tăng độ đóng kín vòm - hầu và lành thương ít gây biến chứng. Chính vì vậy, đây là phương pháp an toàn, khả thi và có thể được áp dụng rộng rãi để điều trị khiếm khuyết trong giọng nói sau tạo hình khe hở vòm miệng.Velopharyngeal insufficiency (VPI) is a common defect in patients with cleft palate after primary cleft surgery, causing to have problems with pronunciation, affecting significantly their quality of life. Pharyngoplasty surgery helps to repair and restore the anatomical defect encountered in patients with cleft palate, however, in Vietnam, there are not many studies evaluating the effectiveness of this surgery. Objective: To describe the clinical characteristics of cleft palate patients with velopharyngeal insufficiency (VPI) and evaluate the improvement in pronunciation and changes in anatomical structure through nasoendoscopic images after pharyngoplasty surgery. Methods: The research method is a cross - sectional study of 40 cleft palate patients diagnosed with velopharyngeal insufficiency at My Thien Hospital from December 2022 to December 2023. Results: The study was conducted on 40 patients with an average age of 16.8 ± 8.62 (years old), 39% of men and 61% of women. 100% of preoperative patients had nasal air emission and resonance disorder. 6 months after surgery, the pronunciation disorder score decreased by 2.63 ± 1.13 (50.1%) compared to before surgery (p <
0.05). One week after surgery, 73.3% of cases healed well, 26.7% healed moderately
After 1 month, all cases achieved good healing. The velopharyngeal closure ratio (VCR) when observed on nasoendoscopy increased by 15.6% after surgery. Conclusion: Surgery helps to significantly improve the patient's pronunciation ability on two criteria: reducing resonance disorder and air emission when speaking
increase velopharyngeal closure and heal wounds with few complications. Therefore, this method is safe, feasible and can be widely applied to treat speech defects after cleft palate surgery.

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