Clinical use of gelatin sponge in palatorrhaphy

doi:10.3969/j.issn.2095-4344.2017.18.018

Abstract

Abstract:

BACKGROUND: In palatorrhaphy, iodoform gauzes are often used to fill the bilateral relaxation incisions and cover the wound. However, there are a series of postoperative complications, such as fever, loss of appetite, foreign body sensation, secondary bleeding. In order to avoid or reduce the complications after palatorrhaphy, the use of gelatin sponge to fill bilateral relaxation incisions has achieved good clinical results.

OBJECTIVE: To compare the clinical effects of different treatments on wound healing after palatorrhaphy．

METHODS: 110 child patients with cleft palate were selected and assigned into two groups according to admission time. Fifty-four patients who admitted from January 2013 to December 2015 (experimental group) were obturated with gelatin sponge, while the other 56 patients who admitted from January 2008 to December 2012 (control group) were obturated with idoform gauze. The postoperative results of patients were assessed in various aspects, including psychological impact, diet, body temperature, bleeding, and wound healing. The incision scar width was measured at 4 weeks postoperatively.

RESULTS AND CONCLUSION: (1) Patients in the experimental group experienced shorter recovery time than those in the control group (P < 0.05). (2) Patients in the experimental group had substantially lower incidence of fever postoperatively, and shorter duration of fever than those in the control group (P < 0.05). (3) In comparison to the control group, the experimental group showed less postoperative complications such as bleeding and vomiting (P < 0.05). (4) The incision scar width in the experimental group was significantly narrower than that in the control group (P < 0.05) after 4 weeks. These experimental findings demonstrate the superior effect of gelatin sponge over iodoform gauze and its value in clinical application with better healing, less bleeding, shorter recovery time and no impact on eating.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

Key words: Cleft Palate, Gelatin Sponge, Absorbable, Biocompatible Materials, Tissue Engineering

CLC Number:

R318

Hu Guang-wei, Liao Tian-an, Wang Tao, Wang Hong.

Clinical use of gelatin sponge in palatorrhaphy

[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(18): 2900-2905.

Figures/Tables 9

2.7 典型病例病例1：患者女，1岁3个月，发现腭部裂开1年余于2015年5月入院。患儿出生后即被发现上腭部裂开，进食时常从鼻孔流出，开始学讲话后，一直语音不清，鼻音明显。门诊以“腭裂”收入口腔科。既往史：无特殊。患儿足月医院顺产，人工喂养，发育及智力同周围同龄幼儿，按社会正常接种计划预防接种。无特殊家族史。患儿近2周内无咳嗽、发热症状。体查：体温36.8 ℃，脉搏90次/min，呼吸20次/min，体质量12 kg。营养发育正常，双侧颌面部对称，颞下颌关节区无压痛。上唇未见裂开。张口度为3横指，张口型正常。口内见腭部自悬雍垂裂开至硬腭中份处，裂隙宽约1.4 cm。腭裂语音明显。双侧扁桃体肿大Ⅰ度。实验室检查：血常规：中性粒细胞百分率 20.3%、淋巴细胞百分率 67.9%、淋巴细胞绝对值6.63×109 L-1、单核细胞绝对值0.77×109 L-1、红细胞4.86×1012 L-1、平均红细胞体积78.2 fL、平均红细胞血红蛋白含量26.3 pg、血小板计数 398×109 L-1、血小板平均体积9.0 fL、血小板容积比 0.361%；血生化：同型半胱胺酸3.9 μmol/L、糖化血清蛋白120 μmol/L、D-3羟丁酸 0.43 mmol/L、肌酐25.0 μmol/L、总蛋白64.8 g/L、谷草转氨酶 48.0 U/L、α羟丁酸脱氢酶 219.6 U/L、磷酸肌酸激酶同工酶29.9 U/L；输血4项：乙肝表面抗体定量 14.837 mIU/mL。心电图：窦性心动过速(哭闹时)。胸片提示：双肺纹理增强。患儿完善相关检查后，遂行全麻手术，采用Von Langenbeck法修复腭裂。手术步骤：全麻插管后，面部常规消毒，铺巾，上开口器，口腔内冲洗、消毒(图2A)；沿双侧硬腭的龈缘下方2 mm切开黏膜，深达骨膜深层，向后直到上颌结节，再弯向外侧，向外向后延伸切口，切开两侧裂隙缘，显露软腭肌肉，前端横过硬腭转向腭部中份，与裂缘切口重叠，切开前用肾上腺素盐水注射切口区，避免较多出血；切开硬腭后在骨膜下分离黏膜骨膜瓣，分离至硬腭骨后缘时保护腭大血管神经束，形成黏膜骨膜瓣；在腭大孔穿出的腭大血管神经周围钝性分离其外周组织，保护血管神经束。显露翼钩和腭帆张肌，稍加钝性分离，拨断翼钩，使黏膜骨膜瓣向内松解；在裂隙缘切口剥离出软腭的鼻侧黏膜瓣，在软硬腭交界处剪断腭键膜附着；缝合悬雍垂及鼻腔侧黏膜，然后缝合肌层，最后缝合口腔侧的软硬腭的黏膜层。双侧松弛切口暴露(图2B)，最宽处约1.2 cm，于松弛切口处各填塞6 cm×2 cm×0.5 cm明胶海绵1块(图2C，D)，利用软腭组织瓣的弹性将切开的松弛切口处组织瓣尽量原位缝合2-4针(图2E，F)，从而消除了骨裸露创面，腭部瘢痕条索的形成，并避免了明胶海绵脱落的风险。患儿术后第1天体温平稳，6 h后精神逐渐恢复，并开始进流质饮食，未出现恶心症状，口腔内未见活动性渗血。1 d后精神基本恢复正常，进食增加，下床自由活动，给予抗炎2 d，于术后第3天安全出院。 "

病例2：患者女，1岁6个月，发现腭部裂开1年余于2010年8月入院。患儿出生后即被发现上腭部裂开，进食时常从鼻孔流出，开始学讲话后，一直语音不清。门诊以“腭裂”收入口腔科。无特殊既往史、个人史、家族史。患儿近2周内无咳嗽、发热症状。体查：体温36.5 ℃，脉搏78次/min，呼吸20次/min，体质量13 kg。口内检查见腭部自悬雍垂裂至硬腭中份，裂隙宽约1.6 cm，硬腭前份未见裂开(图3A)。腭裂语音明显。舌颊黏膜未见明显异常。双侧扁桃体肿大Ⅰ度。实验室检查：血常规：白细胞10.49×109 L-1、中性粒细胞百分率28.5%、淋巴细胞百分率55.5%、淋巴细胞绝对值5.82×109 L-1、单核细胞绝对值0.90×109 L-1、嗜酸性粒细胞绝对值0.76×109 L-1、红细胞4.85×1012 L-1、血小板计数391×109 L-1、大型血小板比率0.106、血小板平均体积8.4 fL、血小板体积分布宽度8.5%、血小板容积比0.330%；血生化：钠135.1 mmol/L、总二氧化碳21.1 mmol/L、肌酐20.0 μmol/L、视黄醇结合蛋白22.72 mg/L、胱抑素C 0.54 mg/L、总胆汁酸35.40 μmol/L、谷草转氨酶36.7 U/L、前白蛋白163.00 mg/L、α羟丁酸脱氢酶239.9 U/L；输血4项：乙肝E抗体定量0.070 PEI U/mL、乙型肝炎病毒前S1抗原阴性(-)S/CO值；凝血4项：活化部分凝血活酶时间41.1 s；胸片、心电图正常。患儿完善相关检查后，遂行全麻手术，采用Von Langenbeck法修复腭裂(手术步骤同病例1)。于双侧松弛切口填塞碘仿纱条，口内制作碘仿纱包压迫腭瓣，缝合固定。患儿术后3 d出现发热，最高达38.9 ℃，精神较差，于第2天开始进极少许流质饮食，伴有恶心，口内分泌物多，口腔内卫生较差，且难以清洗。患儿拆除口内腭部碘仿纱包后，进食量才明显增加，精神逐渐好转。患儿于术后第5天拔除松弛切口碘仿纱条时，出现活动性渗血，患儿非常紧张，哭闹明显，极不配合，给予局部压迫止血，并给予全身止血药物后渗血症状逐渐消失。双侧松弛切口处留有一宽约 1.2 cm的裸露创面(图3B)，延长了伤口愈合时间，患儿于术后第7天安全出院。"

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