悬雍垂腭咽成形术后鼻咽瘢痕狭窄的治疗  

Management of nasopharyngeal stenosis following uvulopalatopharyngoplasty

作　　者：李五一[1] 陈兴明[1] 倪道凤[1] 徐春晓[1] 杨大海[1] 霍红[1] 神平[1] 

机构地区：[1]中国医学科学院协和医科大学北京协和医院耳鼻咽喉科,100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2007年第2期100-103,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家"十五"科技攻关资助项目(2004BA720A17)

摘　　要：目的探讨悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)术后鼻咽瘢痕狭窄的治疗。方法回顾性分析1997年11月至2006年2月北京协和医院耳鼻咽喉科治疗的 UPPP 术后鼻咽狭窄6例患者的临床资料。2例中度(Ⅱ型)狭窄,采用转咽部双黏膜瓣法,重建黏膜化的新软腭外侧游离缘,并修复咽侧裸露的创面,扩大咽腔。4例重度(Ⅲ型)狭窄,曾行1～3次鼻咽狭窄矫治术后失败,其中1例放置网状记忆合金支架后咽闭锁。除了采用上述转咽部双黏膜瓣修复外,4例Ⅲ型患者术后佩戴中空的鼻咽支撑物扩张半年。结果 6例随访9个月～4年,鼻塞等不适症状去除。鼻咽气道狭窄校正,无鼻咽反流症状。间断佩戴自制的牙托式鼻咽扩张支架,能明显减少对日常工作和交往的干扰。结论手术扩大狭窄咽腔,重度者术后佩戴牙托式鼻咽扩张支架,是目前治疗 UPPP 术后鼻咽狭窄较理想的方法。Objective Severe nasopharyngeal stenosis （NPS）is a rare complication ot uvulopalatopharyngoplasty （UPPP） and very difficult to manage. This report presents our successful treatment experience. Methods From Nov 1997 to Feb 2006, 6 adults patients with NPS secondary to UPPP were treated in Peking Union Hospital. Two cases was grade Ⅱ stenosis, received surgery of local pharyngeal and soft palate mucosa flap rotation to enlarge nasopharyngeal airway with stenosis; For the remaining 4 cases with more severe NPS （grade Ⅲ ） who had received 1-3 times unsuccessful repair procedures priviously, prolonged nasopharyngeal hollow obturators were used for 6 months after stenosis repair surgery. Results With 9-48 months follow-up, All cases results were satisfactory. Nasal obstruction symptom was eliminated, NPS corrected, no velopharyngeal insufficiency complication happened . Daytime removable nasopharyngeal hollow stent obturators with palate support device is more comfortable for patients. Conclusions Local flap rotation to enlarge stenosis airway and prolonged use nasopharyngeal hollow obturators are reliable methods of correction NPS following UPPP.

关 键 词：睡眠呼吸暂停 阻塞性 腭 软 手术后并发症 再手术 

分 类 号：R766[医药卫生—耳鼻咽喉科]