阻塞性睡眠呼吸暂停低通气综合征Repose舌骨悬吊术并发症  

Complications of hyoid suspension with Repose system on obstructive sleep apnea hypopneasyndrome

作　　者：陈金辉[1] 罗志宏[1] 杨蕊[1] 康晶 王永平[1] 杨希林[1] 朱明万[1] 陶泽璋[1] 

机构地区：[1]武汉大学人民医院耳鼻咽喉头颈外科鼾症中心,430060 [2]放射科

出　　处：《中华耳鼻咽喉头颈外科杂志》2012年第6期449-453,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：湖北省自然科学基金项目（2009CDtM29）

摘　　要：目的评估治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的Repose舌骨悬吊术并发症，并探讨其发生原因及防治措施。方法2005年6月至2009年7月经多道睡眠监测确诊的OSAHS患者行Repose舌骨悬吊术44例，回顾性分析术中及术后并发症。对主诉吞咽异常者进行饮水试验和x线吞咽动态造影录像检查。结果术中7例（15．9％）患者钛钉脱落，重新择位再次植入钛钉后没有再脱落；无喉上神经及血管损伤、甲状舌骨膜损伤、舌骨骨折、缝线断裂等其他并发症。所有患者术后出现言语困难、饮食呛咳、吞咽困难、舌体运动受限及口底水肿，多在3d后逐渐缓解：术后没有钛钉脱落、伤口脂肪液化、血肿、感染、异物反应、舌感觉障碍、缝线断裂等并发症。患者随访均超过2年。术后2年以上言语困难发生率为4．5％（2／44），表现为说话含糊，流利性差；长期吞咽异常发生率为15．9％（7／44），主要表现为偶有饮水、吃饭呛咳，感觉食物粘在咽喉部吞咽不畅，低头吞咽或感觉食物进入另外的通道。7例吞咽异常患者饮水试验正常，吞咽动作x线动态造影录像检查发现7例均存在舌骨运动减弱和喉头上提幅度减小，没有钡剂吸人气管，其中3例患者存在会厌谷、梨状窝钡剂明显滞留。结论Repose舌骨悬吊术的大多数并发症都可以被有效避免或在短期内恢复，少数患者术后可存在长期言语含糊和吞咽异常，应引起重视。Objective To investigate the complications of hyoid suspension with Repose system on obstructive sleep apnea hypopnea syndrome （OSAHS） and to find out the effective prevention strategies. Methods Forty four patients diagnosed by polysomnography as OSAHS were received hyoid suspension with Repose system from June 2005 to July 2009. The intraoperative and postoperative complications were analyzed retrospectively. The patients who reported abnormal swallowing were evaluated with water drinking test and video fluoragraphy swallow study to assess biomechanical changes in swallowing. Results Incidence rate of perioperative titanium nial amotio was 15.9% （7/44）. It was avoided by implanting titanium nlal again. No perioperative complications occurred such as injury of superior laryngeal nerve, blood vessel and thyrohyoid membrane, fracture of hyoid bone, suture break. All patients developed dysfunctions of pronunciation and swallowing, edema of mouth floor, dysfunctions of movement of tongue that could relievedgradually after three days on most patients. No postoperative complications occurred sucla as mamum real amotio,fat liquoring,edema of mouth floor, hematoma, infection, foreign body reaction, injury of root apex of anterior tooth, dysfunctions of movement and sensation of tongue, suture break and death. All patients had over 2 year postoperative follow up. Incidence rate of dysfunctions of pronunciation and swallowing was 4.5% （2/44） and 15. 9% （7/44） respectively. Main situation for dysfunctions of pronunciation was speaking ambiguity. Major manifestations of swallowing abnormalities were occasional aspiration, food going down the wrong tube, food becoming stuck in the throat, deglutions with bowing head. Seven patients whohad abnormal swallowing possesed normal water drinking test and occurred asynersis of hyoid movement and laryngeal elevation, but aspiration were not observed. Three patients presented obvious stagnation in epiglottic vallecula and sinus piriformis. Conclusions Most complication

关 键 词：睡眠呼吸暂停 阻塞性 舌骨 手术后并发症 手术中并发症 耳鼻喉外科手术 

分 类 号：R766[医药卫生—耳鼻咽喉科]