改良保留悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征疗效分析  

Therapeutic effect of modified Han-uvulopalatopharyngoplasty for obstructive sleep apnea hypopnea syndrome

作　　者：李刚[1] 

机构地区：[1]北京市门头沟区医院耳鼻咽喉科,北京102300

出　　处：《中国耳鼻咽喉颅底外科杂志》2017年第5期470-472,475,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的探讨改良保留悬雍垂腭咽成形术治疗因软腭肥厚导致阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的手术方法及疗效。方法 2013年4月~2014年4月对65例软腭肥厚腭咽平面狭窄的中重度OSAHS患者行软腭正中切开联合改良保留悬雍垂腭咽成形术,术前及术后行上气道CT等相关检查,分析65例患者手术后的疗效及各参数的变化情况。结果 65例患者手术后1年呼吸暂停低通气指数(AHI)由(42.58±5.66)次/h降低至(15.26±3.39)次/h,差异具有统计学意义(P<0.01);最低血氧饱和度由0.743±0.063提高至0.8613±0.053,差异具有统计学意义(P<0.01);Epworth嗜睡量表4个指标均较术前有明显改善(P<0.01)。65例患者中治愈31例(47.7%),显效30例(46.2%),有效3例(4.6%),无效1例(1.5%)。3例患者术后3个月有轻微吞咽障碍及咽痛,2例患者术后7 d出现扁桃体窝出血,局部压迫后止血。结论改良保留悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征术式相对简单,主观疗效较好,且并发症较少,临床可选择性采用。Objective To discuss the surgical method and efficacy of modified Han-uvulopalatopharyngoplasty（MHUPPP） for the treatment of obstructive sleep apnea hypopnea syndrome（OSAHS） caused by soft palate hypertrophy.Methods From April 2013 to April 2014,65 patients suffering from moderate to severe OSAHS with soft palate hypertrophy and palatal pharyngeal stenosis underwent soft palate median incision combined with Han-uvulopalatopharyngoplasty.Before and after operation,all patients received upper airway computerized tomography（CT）and other related examinations.The therapeutic effect was evaluated and the changes of various parameters were analyzed.Results One year after MHUPPP,the apnea hypopnea index（AHI） decreased from（42.58 ± 5.66） to（15.26 ±3.39）,and the lowest blood oxygen saturation（LSa O2） increased from 0.743 ± 0.063 to 0.8613 ± 0.053,the differences were both statistically significant（both P〈0.01）.Postoperative Epworth sleepiness scale was significantly improved compared with that before operation,the difference was also statistically significant（P〈0.01）.Of all the 65 patients,31 patients（47.7%） were cured,30（46.2%） were significantly improved,3（4.6%） were effective and one（1.5%） was ineffective.Three patients had mild postoperative dysphagia and pharyngalgia.Hemorrhage of tonsil fossa occurred in 2 patients at the 7 th day after operation and got cured with local compression only.Conclusions The MHUPPP is a relatively simple procedure for the treatment of OSAHS,subjective curative effect is good,and fewer complications.It can be used selectively in clinic.

关 键 词：改良悬雍垂腭咽成形术 阻塞性睡眠呼吸暂停低通气综合征 软腭正中切开术 Pillar软腭支架植入术 

分 类 号：R766.4[医药卫生—耳鼻咽喉科]