软腭前移悬雍垂腭咽成形术  

Combination of transpalatal advancement pharyngoplasty and uvulopalatopharyngoplasty for obstructive sleep apnea

作　　者：叶京英[1] 伊彪[2] 刘静明[3] 尹国平[4] 王小轶[4] 王丽曼[4] 石兴丽[4] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头,100730 [2]北京大学医学部口腔医学院口腔颌面外科 [3]首都医科大学附属北京同仁医院口腔科,100730 [4]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2007年第2期85-89,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：本课题由北京市科技计划重大项目培育专项课题资助(Z0005190041531)

摘　　要：目的研究联合应用改良悬雍垂腭咽成形术(H-uvulopalatopharyngoplasty,H-UPPP)及硬腭截短软腭前移手术,治疗阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopneasyndrom,OSAHS)的疗效,探索存在骨性鼻咽腔狭窄 OSAHS 患者的治疗方法。方法 32例 OSAHS 患者,年龄27～54岁,平均(±s,以下同)为(39.1±7.8)岁,均为男性,体重指数22.9～36.7 kg/m^2,平均(29.0±3.6)kg/m^2。术前睡眠呼吸暂停低通气指数(apnea and hypopnea index,AHI)11.7～113.7次/h,平均(61.8±21.9)次/h,最低血氧饱和度0.10～0.85,平均0.64±0.13。术前纤维鼻咽喉镜检查,全部患者均存在腭咽部狭窄,合并舌根平面阻塞14例。X 线头影测量:SNA 角72.9°～87.0°,平均(80.7±4.1)°;SNB 角69.5°～85.0°,平均(76.8±4.5)°;PAS 0.5～2.1 cm,平均(1.2±0.5)cm;MP-H 1.2～3.5 cm,平均(2.2±0.7)cm;PNS 2.4～3.5 cm,平均(2.8±0.4)cm。全部患者行软腭前移联合 H-UPPP 手术。14例合并舌后隙轻度狭窄者,同期行颏前徙术。结果术后6个月复查多道睡眠监测,32例患者中总有效27例,其中显效22例(占总例数的68.8%),包括 AHI<5次/h者8例(占总例数的25.0%);无效5例(15.6%)。手术后 Epworth 嗜睡程度评分由术前9.2±4.5下降至4.7±2.8,OSAHS 初筛量度评分由术前56.0±15.3下降至17.5±11.5,差异均有统计学意义(t 值分别为4.058和11.45,P 值均<0.01)。结论硬腭截短软腭前移手术是针对存在骨性鼻咽腔狭窄的 OSAHS 患者有效的治疗方法,联合应用软腭前移手术与 H-UPPP,可以提高其显效率及治愈率,即单纯腭咽平面阻塞的患者有望手术治愈。Objective Investigate the response of the patients with obstructive sleep apnea hypopnea syndrome （OSAHS） patients to combination of transpalatal advancement pharyngoplasty and uvulopalatopharyngoplasty. Methods Thirty two patients with OSAHS, age ranged from 27 to 54, mean value （x ＋ s） 39. 1 ＋ 7. 8, male, body mass index （ BMI ） ranged from 22. 9 to 36. 7 kg/m^2, mean value （ 29. 0 ＋3.6）kg/m^2, preoperative apnea and hypopnea index（AHI） was 11.7/h to 113.7/h, mean value （61.8 ±21.9）/h, the lowest blood oxygen saturation was 0. 10 to 0. 85, mean value 0.64 ± 0. 13. With preoperative endoscopic technique, bony nasopharynx cavity narrowing were present, 14 patients had concomitant tonge-hase obstruction Cephalometric result, SNA ranged from 72. 9° to 87.0°, mean value （80. 7 ±4. 1 ）° ; SNB 69. 5°to 85.0°, mean value （76. 8 ±4. 5 ）° ; PAS 0. 5 cm to 2. 1 cm, mean value （ 1.2 ± 0. 5 ） cm; MP-H： ranged from 1.2 cm to 3.5 cm, mean value （ 2.2 ±0. 7 ） cm; PNS ranged from 2.4 cm to 3.5 cm, mean value （2. 8 ± 0. 4 ） cm. All the patients had H-UPPP and concomitant transpalatal advancement pharyngoplasty. Fourteen patients with tonge-hase obstruction had chin advancement. Results Six months after the operations, the patients were evaluated the response to the operations using Epworth sleep scale, OSAHS filtration questionnaire scale and polysomography （PSG）. There were 27 patients with the decrease percent of AHI reaching or more than 25% and 22 patients with the decrease percent of AHI reaching or more than 50% including 8 patients with AHI less than 5 . The other 5 patients were ineffective. After operation, the Epworth sleep scale decreased from （ 9. 2 ± 4. 5 ） to （ 4.7 ± 2. 8 ） and OSAHS filtration questionnaire scale decreased form （56. 0 ± 15. 3） to （ 17. 5 ± 11.5）. Both of the differences were obvious（P 〈 0. 01 ）. Conclousions Combination of transpalatal advancement pharyngoplasty and H-UPPP can improve the efficacity an

关 键 词：睡眠呼吸暂停 阻塞性 腭 硬 腭 软 耳鼻喉外科手术 治疗结果 

分 类 号：R766[医药卫生—耳鼻咽喉科]