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的临床研究

Clinical Sutdy on Uvulopalatopharyngoplasty for the Treatment of Obstructive Sleep Apnea Syndrome

目的探讨提高悬雍垂腭咽形成术(uvulopalatopharngoplasty,UPPP)疗效、减少并发症的方法方法回顾性研究阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者97例,经全夜7h 多导睡眠图监测确诊 33例局部麻醉下完成 UPPP;64例在全身麻醉下完成。结果术后随访半年,治愈40例(41.23%),显效25例(25.77%),改善17例(17.52%),无效15例(15.46%),总有效率为84.54%。术中出现高血压危象2例,呼吸障碍4例;术后扁桃体出血2例,全身麻醉拔管后立即出现Ⅳ度呼吸困难1例,伤口裂开2例,暂时性腭咽功能不全9例。结论提高疗效、减少并发症的措施包括:扩大软腭成开形范围,重视软腭后区咽侧壁、腭帆间隙的脂肪组织的切除及腭帆张肌和提肌的保护及悬雍垂的部分保留;阻塞部位的术前确定。

Purpose To evaluate the efficacy of uvulopalatopharyngoplasty （UPPP） on the treatment of obstructive sleep apnea hypopnea syndrome （OSAHS） and minimize the postoperative complications. Methods The data of 97 patients with OSAHS diagnosed with polysomnopraphy were analyzed. All patients collected had undergone UPPP with local （33 cases） or general （64 cases） anesthesia. Results Fifteen cases （15.46%） showed unchanged snoring and apnea and hyponea index. Eighty two cases improved after UPPP for at least 6 months in whieh 40 cases were cured （41.23%）, 25 cases significntly improved （25.77%） and 17 cases improved （17.52%）. The complications included hypertensive crisis （2 cases）, respiratory disorders（4 cases） during the operation. After the operation, the complications included local hemorrhage （1 cases）, wound dehiscence （2 eases）, temporal velopalatal insufficiency （9 cases ）and suffocation （1 ease）. Conclusion Our results indicated that the strategies of improving the effect and avoiding complications include： excision of the lateral pharyngeal wall in retroalatal region and fat tissue in soft palate, protection of palatosalpingeus and palatostaphylinus, and part preservation of uvula and confirmation of the obstructive region. （Chin J Ophthalmol and Otorhinolaryngol, 2006,6：296 - 297）