重度阻塞性睡眠呼吸暂停综合征上呼吸道阻塞部位的定位诊断及手术治疗

Localization diagnosis of upper airway stricture in patients with obstructive sleep apnea syndrome and operative therapy

目的探讨对重度阻塞性睡眠呼吸暂停综合征(obstructivesleepapneahypo-apneasyndrome,OSAS)患者进行上呼吸道阻塞部位的定位诊断,并进行针对性的手术治疗,以提高OSAS手术治疗的有效率。方法经PSG确诊的重度OSAS患者共98人,男94人,女4人,上呼吸道阻塞部位的定位诊断方法:清醒状态下的头颈侧位片、上呼吸道纤维内窥镜检查及MULLER动作观察、上呼吸道CT测量等,睡眠状态下的上呼吸道纤维内窥镜检查、上呼吸道CT测量等。根据定位诊断结果实行针对性的手术治疗。结果98例患者均获得明确的上呼吸道阻塞部位定位诊断,根据阻塞或狭窄部位的不同以及造成该阻塞或狭窄的原因不同采用了不同的手术治疗,所有患者术后恢复顺利,无并发症。随访6个月以上,治愈、显效、有效和无效者分别为39、49、6和4例,治愈率、显效率、有效率和无效率分别为39.8%、89.8%、95.9%和4.1%。结论对OSAS患者进行术前上呼吸道阻塞部位的定位诊断,并进行针对性的手术治疗,可以显著提高OSAS手术治疗的有效率。

[Objective] To apply varies operation methods in threapy of patients with obstructive sleep apnea syndrome (OSAS) based on localization diagnosis of upper airway stricture and to get better effect. [Methods] 98 patients with OSAS were included in the study. The localization diagnosis methods as follows: in awake, conventional physical examination, lateral X-ray photograph, fibre end oscopy examination with Muller's maneuver and CT measurements in upper airway, a nd in sleep,fibre endoscopy examination and CT scan in upper airway. And the ope ration plan were made based on localization diagnosis results. [Results] The l ocalization of upper airway stricture were diagnosed in all 98 patients, and the operation methods varied in difference patients based on the difference of stri ciure site in upper airway. All patients recoverd smoothly without any severity complication. All patients were followed up more than 6 months, and the cure, we ll, utility and inefficiency rate were 39.8%?89.8%?95.9% and 4.1% respectively. [Conclusion] In difference patients, applying difference operation methods bas ed on difference stricture site in upper airway, we can get much better cure eff ect.