DISE定位下保留扁桃体窝对阻塞性睡眠呼吸暂停低通气综合征患者的治疗意义  

Clinical significance of preserving tonsillar fossa for obstructive sleep apnea hypopnea syndrome helping by preoperative DISE examination

作　　者：朱梅[1] 白雪[1] 王钰彧 ZHU Mei;BAI Xue;WANG Yu-yu(Department of Otolaryngology Head and Neck Surgery,Beijing Friendship Hospital,Capital Medical Univercity,Beijing 100050,China.)

机构地区：[1]首都医科大学附属北京友谊医院耳鼻咽喉头颈外科,北京100050

出　　处：《临床和实验医学杂志》2018年第15期1650-1654,共5页Journal of Clinical and Experimental Medicine

基　　金：扬帆计划-北京市医管局临床技术创新项目(编号:12016B4016)

摘　　要：目的通过药物诱导睡眠喉镜(DISE)检查准确定位后,在悬雍垂腭咽成形术(UPPP)基础上行保留扁桃体窝及低温等离子射频消融咽侧索的手术,探讨手术的远期疗效。方法回顾性分析2014年1月至2016年1月首都医科大学附属北京友谊医院耳鼻咽喉头颈外科收治的经多导睡眠监测(PSG)确诊为阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的轻、中度患者49例,均进行DISE检查,其中25例患者提示口咽平面左右径狭窄且无咽侧索肥厚(组1),24例患者口咽平面环形狭窄且伴有咽侧索肥厚(组2)。组1中行传统UPPP手术14例(组1-1),行保留扁桃体窝的UPPP手术11例(组1-2);组2中行传统UPPP手术12例(组2-1),行保留扁桃体窝的UPPP及低温等离子消融部分肥厚咽侧索手术12例(组2-2)。术后1年患者门诊随访,复查上气道手术部位恢复情况,并行一夜多导睡眠检测,收集术后的Epworth嗜睡量表(Epworth sleeping scale,ESS)评分,呼吸暂停低通气指数(AHI),最低血氧值(LSaO_2)。结果根据《2009年中华医学会耳鼻咽喉头颈外科学分会关于OSAHS的诊断和治疗指南》中疗效评估标准,组1治愈5例,其中组1-2:3例,组1-1:2例;显效和有效共12例,其中组1-2:7例,组1-1:5例;无效8例,其中组1-2:1例,组1-1:7例,总有效率为68%。组2治愈3例,其中组2-2:2例,组2-1:1例;显效和有效共13例,其中组2-2:8例,组2-1:5例;无效8例,其中组2-2:2例,组2-1:6例,总有效率为66.7%。两组患者间年龄、BMI、LSaO_2、术前AHI差异均无统计学意义(P>0.05),术后AHI组1-2和组2-2低于组1-1和组2-1(P<0.05)。结论 UPPP手术基础上保留扁桃体窝手术远期疗效较好,对手术治疗OSAHS的远期疗效有重要意义;对于咽侧索肥厚患者使用低温等离子消融部分咽侧索对咽腔的扩大起到极大作用;术前使用DISE定位检查对手术方式的选择起到重要指导作用。Objective After the accurate location by the drug induced sleep laryngoscope（ DISE）,uvulopalatopharyngoplasty（ UPPP）surgery and modified uvulopalatopharyngoplasty surgery were performed respectively for treatment of OSA. Then the long-term effect of the patients was discussed. Methods 49 subjects diagnosed with OSA were included in this retrospective study. DISE examination was conducted and found out 25 subjects with tranversal obstruction of oral plan（ termed Group 1） and 24 subjects with circle obstruction of oral plan and hypertrophy of lateral pharyngeal bands（ termed Group 2）. 14 subjects received traditional uvulopalatopharyngoplasty（ termed Group 1-1） and 11 subjects received modified uvulopalatopharyngoplasty（ termed Group 1-2） in Group 1,while 12 received traditional uvulopalatopharyngoplasty（ termed Group 2-1） and 12 received modified uvulopalatopharyngoplasty（ termed Group 2-2） in Group 2. Polysomnography was conducted a year after surgery to evaluate surgery outcomes. Results According to the evaluation criteria of the guidelines for the diagnosis and treatment of OSAHS in the Chinese nasopharyngeal and laryngology and cervical surgery branch of the Chinese Medical Association in 2009,5 cases were cured in group1. Group 1-2： 3 cases,group 1-1： 2 cases. Total effective cases was 12,including group 1-2： 7,group 1-1： 5 cases; 8 cases were invalid,the group 1-2： 1 cases,1-1： 7 cases,The total effective rate is 68%. 3 cases were cured in Group 2,of which group 2-2： 2 cases,group 2-1： 1 cases,total effective cases was 13,including group 2-2： 8 cases,group 2-1： 5 cases,and 8 cases were invalid,of which group 2-2： 2 cases,group 2-1： 6 cases,The total effective rate was 66. 7%. There was no significant difference in age,BMI,LSaO_2 and preoperative AHI between the two groups（ P〈0. 05）. AHI in group 1-2 and group 2-2 were lower than those in group 1-1 and group 2-1（ P〈0. 05） after operation. Conclusion The long-term curative effect of preservin

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 悬雍垂腭咽成形术 低温等离子消融 药物诱导睡眠喉镜 扁桃体窝 

分 类 号：R766[医药卫生—耳鼻咽喉科]