多平面同期手术治疗中重度阻塞性睡眠呼吸暂停低通气综合征  

One-stage multiplanar operation in treatment of moderate and severe obstructive sleep apnea syndrome(OSAHS)

作　　者：王杰[1] 柳庆君[1] 

机构地区：[1]四川省绵阳市中心医院,四川绵阳621000

出　　处：《山东大学耳鼻喉眼学报》2012年第2期18-22,共5页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：四川省科技厅科技支撑项目(09-06-0701077)

摘　　要：目的探讨上气道多平面同期手术在中重度阻塞性睡眠呼吸暂停低通气综合征患者(OSAHS)治疗中的价值。方法收集整理我科169例存在多个平面阻塞征象的OSAHS患者的术前基本情况、手术方案与术后随访资料及总住院费用、总住院天数等,分析不同手术方案的优缺点、多平面同期手术前后并发症状况及救治经验、不同手术方案的费用与时间耗费等。结果 169例中,接受多平面同期手术81例,其中腭咽及鼻平面同期手术70例,腭咽及舌根后气道平面同期手术9例,保留悬雍垂腭咽成形术(H-UPPP)合并鼻甲消融及舌根消融2例。选择序贯手术29例,即一期处理鼻或腭咽平面,半年后行另一平面手术。59例仅接受H-UPPP。围手术期无死亡等严重并发症发生,随访时间半年到2年,依据术前术后多导睡眠监测(PSG)检查结合嗜睡量表评分(ESS)评估手术疗效。多平面同期手术在改善睡眠呼吸暂停低通气指数(AHI)、氧减指数(ODI)等方面效果与序贯治疗组相近,均优于单纯H-UPPP。多平面手术总体有效率为88.9%,单一平面为66.1%。单纯H-UPPP平均住院费用为(7 500±439)元,住院日(9.8±1.3)d,多平面同期手术平均住院费用为(10 541±1 043)元,住院日(11.4±1.5)d,多平面序贯手术平均住院费用为(14 500±1 097)元,总住院日(18.6±2.1)d。多平面同期手术后近期误呛与吞咽困难发生率34.6%(28/81)高于单一平面手术11.9%(7/59)。结论对于具有不同平面阻塞征象的患者,采用多平面同期手术与多平面序贯手术疗效均优于单纯H-UPPP,多平面同期手术与多平面序贯手术疗效差异无统计学意义。同期手术缺点在于并发症较单一平面手术或序贯手术为多,且同期手术平均住院费用及平均总住院日显著低于序贯手术。上气道多平面同期手术是治疗中重度OSAHS的较好方案。Objective To analyze therapeutic effects,complications,total maintenance charge and total hospitalization days of 169 OSAHS cases,and to discuss the value of multiplanar operation of the upper airway in the treatment of moderate and severe OSAHS sufferers.Methods The clinical data of 169 OSAHS patients who showed multiplannar blocking signs from August 2001 to January 2010,including operation scheme,PSG altogether with Epworth sleepiness score before and after operation,total hospitalization expences and total hospitalization days,were reviewed.The advantages and disadvantages of different operation plans,rescuing experience and the tactics dealing with complications were discussed.Reasults In the 169 OSAHS sufferers,81 received one-stage multiplanar operation,including 70 nasal /palatopharyngeal plane operation,9 palatopharyngeal/tongue base plane operations,and 2 H-UPPP/tongue base radiofrequency reduction/nasal ablations.29 chose consecutive surgical therapy in which nasal plane or palatopharyngeal plane operation was first done,and the operation on another plane done later.59 acepted H-UPPP only.No death or serious complications occurred in the perioperation period and follow up（0.5 to 2 years）.Epworth sleepiness score and PSG before and after operation were used to evaluate the therapeutic effects.Compared to the single H-UPP,one-stage multiplanar operation and consecutive multiplanar operation both showed advantages in decreasing AHI and ODI,but no significant difference in decreasing ESS or raising SaO2min among the three types of operations was identified.The overall effective rates of the multiplanar operation group and the single H-UPPP group were 88.9%（72/81）,66.1%（39/59）,respectively.For single H-UPPP,the mean hospitalization charge was 7 500±439 yuan,and the mean hospitalization stay was 9.8±1.3 days,while for the one-stage multi-planar operation group and consecutive multiplanar operation group,the corresponding data were 10 541±1 043 yuan,11.4±1.5 days,14 500±1 097 yuan and 18.6±2

关 键 词：睡眠呼吸暂停 阻塞性 多平面手术 一期手术 序贯治疗 

分 类 号：R766.7[医药卫生—耳鼻咽喉科]