幼児における口唇口蓋裂の一段階修復。レトロスペクティブ・レビュー：実現可能性と手術の経験

Single Stage Cleft Lip and Palate Repair In Toddlers: Retrospective Review of Feasibility and Operative Experience.

抄録

ABSTRACT:

唇口蓋裂（CLP）の小児において，1段階手術群またはAll in one（AIO）アプローチと，2段階手術群（2-SSG）をそれぞれ18名と12名の幼児で比較することを目的とした。2007年から2019年にかけて、CLP患者30名のレトロスペクティブレビューを実施した。All in one手術は12～24カ月に、2-SSG患者は3～9カ月に唇と一次鼻の矯正を行い、12～16カ月に口蓋形成術とミリングトミーが行われました。AIO群では13例（72.2％）が片側CLP，5例（27.8％）が両側CLPで，2-SSGの片側CLP8例（66.7％），両側CLP3例（25％），粘膜下CPによる不完全なCL1例（8.3％）と同程度であった。2-SSGは累積手術時間が30分長く，出血量も増加したが，統計的に有意ではなかった（それぞれP = 0.149，0.219）．AIO群は挿管期間が0.67日対0.33日、小児集中治療室入院期間が1.72日対1.67日とそれぞれ若干長かった（P = 0.427, 0.927 ）。総入院日数はAIOの方が有意に短かった（8日対10.67日、P = 0.016）。術後の小児集中治療室の期間と補助酸素の必要性はAIOで高かった（38.9％対8.3％、P = 0.064）。12カ月から24カ月までの口唇・鼻・口蓋手術の「AIO」アプローチにより、1回の手術で早期外科治療が完了する。しかし、我々のレビューによると、このプロトコルは選択的でなければならず、併存疾患や症候群のある子どもは除外し、段階的に手術することが勧められている。

ABSTRACT: In children with cleft lip and palate (CLP), we aimed to compare a single-stage surgery group or all in one (AIO) approach with a 2-stage surgery group (2-SSG) of 18 and 12 toddlers, respectively. A retrospective review of 30 patients with CLP was conducted between 2007 and 2019. All in one procedure was performed at 12 to 24 months and 2-SSG patients had lip and primary nasal correction at 3 to 9 months, followed by palatoplasty and myringotomies at 12 to 16 months. In the AIO group, 13 (72.2%) patients had unilateral CLP, while 5 (27.8%) had bilateral CLP, which is comparable to the 2-SSG who had 8 (66.7%) unilateral CLP, 3 (25%) bilateral CLP, and 1 (8.3%) incomplete CL with submucous CP. The 2-SSG had a 30 minutes longer cumulative operative time and increased blood loss that was not statistically significant (P = 0.149 and 0.219, respectively). The AIO group had a slightly longer intubation (0.67 versus 0.33 day) and pediatric intensive care unit admission duration of 1.72 versus 1.67 days, (P = 0.427, 0.927), respectively. Total hospitalization time was significantly shorter with the AIO (8 versus 10.67 days, P = 0.016). The duration of postoperative pediatric intensive care unit and need for supplemental oxygen were higher in the AIO (38.9% versus 8.3%, P = 0.064). The "AIO" approach of lip, nasal, and palate surgery from 12 to 24 months completes early surgical care in a single operation. However, based on our review, this protocol must be selective; children with comorbidities or syndromes are advised to be exempted and operated in stages.