Friedman Ⅰ型阻塞性睡眠呼吸暂停低通气综合征患者单纯扁桃体切除术的应用价值  

Value of tonsillectomy in patient with obstructive sleep apnea hypopnea syndrome with Friedman staging Ⅰ

作　　者：陈怀宏[1] 李湘平[1] 叶辉[2] 彭宏[1] 李丹青[1] 

机构地区：[1]南方医科大学南方医院耳鼻咽喉科,广州510515 [2]中山大学附属第二医院耳鼻咽喉科

出　　处：《中华耳鼻咽喉头颈外科杂志》2012年第2期107-111,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 探讨单纯扁桃体切除术对于成人Friedman Ⅰ型阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者治疗的可行性.方法 2004年1月至2010年3月,对56例不接受悬雍垂腭咽成形术（UPPP）手术的Friedman Ⅰ型OSAHS患者（轻度20例,中度24例,重度12例）单纯行扁桃体切除术；同期接受UPPP手术的Friedman Ⅰ型OSAHS患者68例作为对照组（轻度26例,中度28例,重度14例）.结果 两组患者术前年龄、体质量指数（BMI）、呼吸暂停低通气指数（AHI）、最低血氧饱和度、平均血氧饱和度等各因素具有可比性.经秩和检验,两组手术时间（U=0.000,P＜0.01）、住院日数（U =458.5,P＜0.01）、术后疼痛视觉模拟量表评分（U =0.000,P＜0.01）,差异均有统计学意义.术后1年或1年以上随访,两组的BMI、AHI、最低血氧饱和度、平均血氧饱和度等各项参数经t检验证实差异无统计学意义（P值均＞ 0.05）；两组治疗有效率分别为82.1％（ 46/56）和73.5％（ 50/68）,连续校正卡方检验差异无统计学意义（x2=0.857,P＞0.05）；其中重度Friedman Ⅰ型OSAHS患者,扁桃体组手术有效率8/12,UPPP组手术有效率11/14,Fisher精确概率检验差异无统计学意义（P＞0.05）.结论 对于以扁桃体肥大为主要结构负荷的Friedman Ⅰ型OSAHS患者,单纯扁桃体切除术安全、有效,可作为此类患者的首选术式.Objective To evaluate the availability of tonsillectomy in patients with obstructive sleep apnea hypopnea syndrome （OSAHS） staged as Friedman Ⅰ.Methods Fifty-six patients with OSAHS in Friedman stage Ⅰ who refused uvulopalatopharyngoplasty （UPPP） received tonsillectomy merely from January 2004 to March 2010.There were 20 mild,24 moderate and 12 serious patients respectively in this group.The other 68 OSAHS patients in Friedman stage Ⅰ received UPPP at the same time as matched group,including 26 mild,28 moderate and 14 serious patients.Results There was no significant difference before operation in terms of age,body mass index,apnea hypopnea index （ AHI）,the lowest pulse oxygen saturation （ SPO2 ） and average SPO2 between the two groups.There were significant difference in mean length of operation（ U =0.000,P 〈0.01 ）,hospitalization day（ U =458.5,P 〈0.01 ）,visual analogue scale after surgery（ U =0.000,P 〈 0.01 ） in these two group.There was no significant difference in surgical effective rate between the two groups （ x2 =0.857,P 〉 0.05 ）.There was also no significant difference in terms of age,body mass index,AHI,the lowest SPO2 and average SPO2 after operation between the two groups （t test P 〉 0.05）.The surgical effective rate for the long term of the two groups was equal （ x2 =0.857,P 〉 0.05）.Even patients with serious OSAHS in Friedman stage Ⅰ,the surgical effective rate of the two groups was equivalent （Fisher＇s exact test,P 〉 0.05 ）.Conclusions Tonsillectomy is a safe and effective surgery for OSAHS in Friedman stage Ⅰ,whose main structural load lies in the hypertrophic tonsil. It should be the first surgical choice for OSAHS in Friedman stage Ⅰ.

关 键 词：睡眠呼吸暂停 阻塞性 扁桃体切除术 耳鼻喉外科手术 

分 类 号：R766[医药卫生—耳鼻咽喉科]