改良UPPP术中切除部分腭咽肌的术后并发症临床研究  

The clinical investigation of the potential complications of post-improved UPPP surgery which removed the partial pharyngeal muscle

作　　者：张峰 杨怀安[2] 

机构地区：[1]辽宁省辽阳市第二人民医院耳鼻喉科,辽宁辽阳111000 [2]中国医科大学附属第一医院耳鼻喉科,辽宁沈阳110000

出　　处：《中国当代医药》2013年第13期30-32,34,共4页China Modern Medicine

摘　　要：目的探讨改良悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)术中切除腭咽肌术后可能出现的并发症及临床转归特点。方法选择经多导睡眠监测确诊的临床资料完整的28例阻塞平面在口咽部的阻塞性睡眠呼吸暂停低通气综合征(OSHAS)患者,于全麻下行改良UPPP手术,术中切除部分腭咽肌,术后对切除腭咽肌可能出现的并发症如鼻腔返流、咽鼓管功能障碍等随访观察6个月,术后每个月通过术后复查或电话随访的方式了解病情,分析其临床变化特点,术后6个月采用ESS(epworth sleepiness scale)量表评价嗜睡状态,与术前ESS评分对比,应用t检验进行统计分析。结果术后1个月内进食后鼻腔返流较多(89.3%),5个月后症状消失;有4例(14.3%)术后1个月出现吞咽障碍,2个月后症状消失;未见耳闷、听力下降、自家音增大等反应咽鼓管功能障碍的并发症;有6例(21.4%)患者感觉发音改变,2个月后症状消失接近原来状态;ESS评分:术前(18.39±3.72)分,术后第6个月(3.46±2.21)分,前后差异有统计学意义(P<0.01),说明术后嗜睡症状明显改善。结论改良UPPP术中切除部分腭咽肌术后6个月未出现咽鼓管功能障碍,软腭功能、吞咽功能及构音功能在6个月内均可恢复正常。术后6个月嗜睡症状消失达到正常状态。Objective To investigate the potential complications and the characteristics of clinical outcome of postimproved UPPP surgery which removed the partial pharyn-geal muscle. Methods To choose 28 OSAHS patients diagnosed by polysomnography （PSG） with obstructive oropha-ryngeal plane and complete clinical data inpatients in the anesthesia underwent a H-UPPP, surgical removal of the partial pharyngeal muscles in the postoperative removal of the partial pharyngeal muscle of possible concurr symptoms such as nasal regurgitation, Eustachian tube dysfunction and other follow-up study in six months after the monthly telephone follow-up or outpatient exams to understand the disease, analysis of changes in its clinical features, evaluate the sleepiness by ESS （epworth sleepiness scale） in 6 months after the surgery, compared with the preoperative ESS scores, do a t test for statistical analysis. Results Within one month after the surgery the nasal regurgitation after eating was much more （89.3%）, and it disappeared in five months; 4 patients （14.3%） suffered a swallowing disorder in one month after the surgery, the symptom disappeared in two months; There was no ear fullness, hearing loss, increase their own sound which reflect eustachian tube dysfunction and other complications; 6 patients （21.4%） feel pronunciation changes, the symptoms disappeared in 2 months. ESS score： Preoperative （18.39 ±3.72） scores, after the first 6 months （3.46 ± 2.21） scores, the difference was significant （P 〈 0.01）, indicating significant improvement in symptoms of the lethargy. Conclusion After removing the partial pharyngeal muscle there are not eustachian tube dysfunction after improved UPPP surgery, and the soft palate rune tion, swallowing and articulation function can be back to normal in six months. The symptoms of sleeiness disappeared, turning to normal state in 6 months after the improved surgery.

关 键 词：阻塞性睡眠呼吸暂停 并发症 腭咽肌 ESS 

分 类 号：R76[医药卫生—耳鼻咽喉科]