悬雍垂腭咽成型术的临床初步筛选  

Primary Screening of the Indications of Uvulopalatopharyngoplasty

作　　者：郑雪松[1] 后农生[1] 郝锐[1] 李桂芝[2] 

机构地区：[1]北华大学附属医院,吉林吉林132011 [2]吉林大学第二临床医院,吉林长春130041

出　　处：《北华大学学报（自然科学版）》2007年第3期251-255,共5页Journal of Beihua University（Natural Science）

摘　　要：目的 探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者以扁桃体及舌体大小为基础的临床分期及悬雍垂腭咽成形手术适应证的选择.方法 回顾2001～2004年在我院收治的33例资料完整、实施UPPP手术并有随访记录的OSAHS的病例资料,参考2002年Friedman分期标准,按扁桃体大小和舌体大小将其分为Ⅲ期,1期为舌体Ⅰ或Ⅱ,扁桃体Ⅱ或Ⅲ;2期为舌体Ⅲ或Ⅳ,扁桃体Ⅱ或Ⅲ;3期为舌体Ⅲ或Ⅳ,扁桃体0或Ⅰ.经UPPP手术治疗后疗效根据比较各组成功率.参考国外资料,根据AHI降低的程度将疗效分为成功和失败两种结局,术后AHI较术前降低≥50%,且AHI＜20次/h,症状明显减轻者为手术成功;余为失败.并就病情严重程度和体重指数对术后疗效的影响进行分析.结果 术后随访及问卷调查结果示：1期患者手术成功率为81.8%,2期患者手术成功率为41.2%,3期患者手术成功率为0.1期患者UPPP术后AHI对比术前有降低,差异具有显著性（P＜0.01）.而2期和3期患者术前术后AHI比较无显著差异（P＞0.05）.UPPP手术疗效与OSAHS患者术前病情严重程度无明显相关性,BMI＜30 kg/m2的患者UPPP手术疗效较好.结论 根据舌体大小和扁桃体大小的临床分期可决定UPPP手术的成功率.Objective To valuate clinical staging system based on tongue size and tonsil size, and select surgical indications of uvulopalatopharyngoplasty（UPPP）. Methods We retrospectively reviewed 33 patients and divided into three stages based on tongue size and tonsil size, who had complete case document, operated with UPPP successfully and then followed up. Refer to Friedman staging standard in 2002, stage 1 was defined as having tongue size Ⅰ or Ⅱ combined with tonsil size Ⅱ or Ⅲ. Stage 2 was defined as having tongue size Ⅲ or Ⅳ and tonsil size Ⅱ or Ⅲ. Stage 3 was defined as having tongue size Ⅲ or Ⅳ and tonsil size 0 or Ⅰ . The results of UPPP were graded as success or failure as based on postoperative polysomnography results and the curative efficiency was compared with each stage. Success of UPPP was defined as a reduction of AHI to 50 % and less than 20 times an hour. This study was also to analyse the severity of OSAHS and body mass index on the effect of the surgical efficiency of UPPP. Results The results of follow-up and questionnaire examination demonstrated： patients who underwent UPPP in Stage 1 had curative efficiency of 81.8%, stage 2 had curative efficiency rate of 41.2%, and patients in stage 3 had curative efficiency of 0. Stage I preoperative and postoperative AHI values were significantly lower. Patients in stage 2 and stage 3, postoperative mean AHI did not differ from preoperative values. The surgical efficiency of UPPP had not be relative to the severity of OSAHS, and was better in patients with BMI 〈30 kg/m^2.Conclusion A clinical staging system for OSAHS based on tongue size and tonsil size appears to be a valuable predictor of the success of UPPP.

关 键 词：OSAHS 成型术 悬雍垂腭咽(UPPP) 

分 类 号：R76[医药卫生—耳鼻咽喉科]