腭咽环扎术后并发阻塞性睡眠呼吸暂停低通气综合征的手术治疗  

Surgical treatment of obstructive sleep apnea hypopnea syndrome after velopharyngeal ring ligation procedure

作　　者：王克涛[1] 魏奉才[1] 范献良[2] 赵华强[3] 王秋芹[4] 谈万业[1] 

机构地区：[1]山东大学齐鲁医院口腔颌面外科,山东济南250012 [2]山东大学耳鼻咽喉科学重点实验室,山东济南250012 [3]山东大学口腔医学院,山东济南250012 [4]滨州医学院附属医院耳鼻喉科,山东滨州256603

出　　处：《上海口腔医学》2005年第3期227-230,共4页Shanghai Journal of Stomatology

摘　　要：目的:探讨环扎线取出术联合腺样体切除术对腭咽环扎术(VRLP)后阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的治疗作用。方法:应用鼻咽纤维喉镜检查6例VRLP后经多导睡眠监测(PSG)确诊为OSAHS患者的上气道形态和腭咽闭合情况,并对患者实施了环扎线取出术和腺样体切除术。术后随访3个月,并进行多导睡眠监测和鼻咽纤维喉镜检查。应用配对t检验和χ2检验对手术前后PSG各检测指标进行了比较。结果:VRLP后上气道在软腭平面形成一环形嵴,OSAHS患者均有腺样体增生肥大,上气道鼻咽部明显狭窄变形。环扎线取出和腺样体切除后,无1例出现腭咽闭合不全,患者上气道形态平滑,睡眠呼吸障碍得到治愈,临床症状消失,睡眠结构恢复正常。PSG各参数在手术前后有极显著性差异(P<0.01)。结论:环扎线取出术联合腺样体切除术,是治疗VRLP后OSAHS的有效方法。PURPOSE:To evaluate the effect of removal of ligation thread combined adenoidectomy in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) after velopharyngeal ring ligation procedure(VRLP). METHODS: The upper airway was examined with dynamic fiberoptic pharyngoscope in six patients with cleft palate who were diagnosed as OSAHS by polysomnography(PSG) after VRLP. All the patients underwent removal of ligation thread and adenoidectomy. Three months after operation, they were recalled back and were examined with polysomnography and dynamic fiberoptic pharyngoscope. The preoperative and postoperative PSG data were analysed with t test and chi-square test to determine the statistical differences. RESULTS: In patients with OSAHS after VRLP, a ring scar was observed on the upper airway at the soft palate level and a remarkable narrow nasopharyngeal meatus was found mainly because of adenoidal hypertrophy. After removal of ligation thread and adenoidectomy, no velopharyngeal incompetence was found, the upper airway morphology was smooth, respiration disorder during sleeping was completely disappeared and sleep architecture became normal. There were significant differences between preoperative and postoperative PSG data. CONCLUSION: Removal of ligation thread combined adenoidectomy was an effective treatment for OSAHS after VRLP.

关 键 词：腭裂 腭咽环扎术 阻塞性睡眠呼吸暂停低通气综合征 腺样体切除术 手术治疗 

分 类 号：R766.9[医药卫生—耳鼻咽喉科]