扁桃体大小对悬雍垂腭咽成形术疗效评估的意义

Evaluating significance of the tonsil size on uvulopalatopharyngoplasty

目的:探讨扁桃体大小对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者行悬雍垂腭咽成形术(UPPP)疗效评估的意义。方法:分析主要存在腭咽平面狭窄而行UPPP手术的60例OSAHS患者术后1年以上疗效、Epworth嗜睡评分(ESS)、PSG主要指标的变化。结果:不同扁桃体大小组术前的各项指标(年龄、AHI、BMI、最低SaO2)总体均数间差异无统计学意义(P>0.05),但术后各扁桃体组间疗效差异有统计学意义(χ2=4.28,P=0.039);扁桃体Ⅰ度肿大组(A组28例)临床症状明显改善(包括显效和有效)17例,扁桃体Ⅱ、Ⅲ度肿大组(B组32例)临床症状明显改善27例。Epworth嗜睡评分:A组由术前的13.7±4.6下降为8.5±3.8(t=4.61,P=0.000 0),B组由术前的14.2±4.5下降为7.5±3.3(t=6.79,P=0.000 0);但两组之间比较无明显差异(t=1.091 2,P=0.279 7);多导睡眠监测(PSG)指标B组AHI下降更明显,两组比较有统计学差异(t=2.37,P=0.021)。两组最低SaO2及微觉醒指数提高明显,但两组之间比较无统计学差异。结论:扁桃体较大的OSAHS患者行UPPP手术有较好的治疗效果,其AHI也有更显著的改善。

Objective： To evalute how the tonsil size affects the efficacy of patients with obstructive sleep apnea hypopnea syndrome （OSAHS） treated with uvulopalatopharyngoplasty （UPPP）. Methods： Sixty cases of OSAHS treated with UPPP in our department were analyzed retrospectively. The clinic curative effect, Epworth sleepiness scale （ESS） and polysomnography（PSG） were examined one year or longer after operation. Results： There was no statistical difference between different tonsil size groups in age, apnea hypopnea index（AHI）, body mass index（BMI） and lowest oxygen saturation（LSaO2 ） before operation. The curative effect was found in 17 cases of smaller tonsils（group A, 28 cases） ,while in 27 cases of bigger tonsils（group B, 32 cases）. There was a statistical difference in curative effect after operation between the two groups（ x^2 = 4.28, P = 0.039）. The ESS was obviously reduced in the two groups after operation（ t = 1.091 2, P = 0.2797）. Among PSG parameters, the AHI, LSaO2 and microarousal index were obviously improved after operation in both groups, but AHI was obviously reduced in group B than in group A （ t = 2.37, P = 0. 021 ）, the LSaO2 and microarousal index had no statistical differences between the two groups. Conclusion： Patients with bigger tonsil will receive a better clinic curative effect after UPPP and the AHI will be improved obviously.