悬雍垂腭咽成形手术适应证初步探讨

Primary evaluation of the indications of uvulopalatopharyngoplasty

目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS)患者口咽腔狭窄的临床分期及悬雍垂腭咽成形(uvulopalatopharyngoplasty,UPPP)手术适应证。方法回顾性分析66例OSAHS患者体重指数(bodymassindex,BMI)、腭舌平面位置、扁桃体大小和咽侧壁肥厚程度等临床资料,对口咽腔狭窄进行临床分期将腭舌平面1 ~2级(无明显舌体肥厚)的患者定为临床Ⅰ期(32例);腭舌平面3 ~4级(有舌体肥厚)的患者定为临床Ⅱ期( 34例);其中扁桃体0~1级的患者分别为Ⅰa期(5例)和Ⅱa期(10例),扁桃体2 ~4级的患者分别为Ⅰb期(27例)和Ⅱb期(24例)。分析UPPP手术前后多道睡眠仪(polysomnography,PSG)监测结果。结果术后1~2年PSG监测显示UPPP手术疗效在病情严重程度不同(以术前睡眠呼吸暂停低通气指数和最低血氧饱和度为标志)的各组患者之间差异无统计学意义(P> 0 05);BMI<30kg/m2 的患者疗效较好(P<0 05);以术后睡眠呼吸暂停低通气指数<20次/h并且较术前下降≥50%,临床症状明显减轻为手术成功,其中腭舌平面1 ~2级、扁桃体2 ~4级的Ⅰb期患者手术成功率( 70 4%,19 /27)明显高于其余各期(Ⅰa 0;Ⅰb 70 4%;Ⅱa 20 0%;Ⅱb 16 7% )。结论以腭舌平面和扁桃体大小为基础的口咽腔狭窄的临床分期。

Objective To evaluate the indications of uvulopalatopharyngoplasty(UPPP) and clinical staging for oropharyngeal narrow in patients with obstructive sleep apnea hypopnea syndrome(OSAHS). Method Sixty-six OSAHS patients were retrospectively analyzed, the data of physical examination and clinical staging for oropharyngeal narrow were built based on body mass index(BMI), palate-tongue position, tonsil sizes and hypertrophy degree in lateral side of oropharynx. The patients who had palatine-tongue position in degree 1 to 2 (no significant tongue enlargement) were defined as stage Ⅰ(32 cases). The patients who had palatine-tongue position in degree 3 to 4 (tongue enlargement) were defined as stage Ⅱ(34 cases). Among them, the patients with tonsil sizes 0 to 1 were stage Ⅰa(5 cases)and stage Ⅱa (10 cases), another group with tonsil size 2 to 4 were stage Ⅰb (27 cases)and stage Ⅱb(~24 cases ), respectively. The indications of UPPP were evaluated according to the results of polysomnography(PSG) before and after operation. Results PSG in 1 to 2 years after operation showed: the surgical efficiency of UPPP had not any difference(P> 0.05) among different groups with the severity of OSAHS(labeled in preoperational AHI and LSaO_2). Surgical results was better in patients with BMI<30 kg/m2 ^(P=0.023 ). Success of operation was defined as postoperational AHI<20/h and reduced more than 50% compared to preoperational AHI and symptoms alleviated significantly. Successful rates of UPPP in stage Ⅰb (70.4%,19/27 cases) were statistically higher than that of other groups(Ⅰa:0%;Ⅰb:70.4%;Ⅱa:20.0%;Ⅱb:16.7%)。 Conclusions Clinical staging system for oropharyngeal narrow is based on palate-tongue position and tonsil size. It is helpful to choose the surgical indications of UPPP for patients with OSAHS. It is the best UPPP indication for stage Ⅰb patients who had no tongue enlargement (palatine-tongue position 1 to 2) and accompanied with enlargement of tonsil size (in degree 2 to 4) and their sleep breathing disorder could be alleviated through UPPP.