悬雍垂腭咽成形术与双颌前徙术联合治疗阻塞性睡眠呼吸暂停低通气综合征的初步报告

Uvulopalatopharyngoplasty and maxillomandibular advancement for obese patients with obstructive sleep apnea hypopnea syndrome:a preliminary report

目的在采用双颌前徙术(maxillomandibular advancement,MMA)的同时结合计算机辅助设计悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP),探索其治疗重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的可行性和疗效。方法严重OSAHS 肥胖患者9例,年龄(47.8±9.7)岁,体重指数(body mass index,BMI)为(35.3±2.5)kg/m^2,睡眠呼吸暂停低通气指数(apnea and hypopnea index,AHI)为(88.7±6.7)次/h。对所有患者行计算机辅助设计的 UPPP 和 MMA 联合手术治疗。患者术前、术后3、6、12个月行多道睡眠检测(polysomnography,PSG)监测,同时进行上气道测量分析,以及腭咽闭合功能、语音评价。结果患者上颌骨 LeFort-Ⅰ截骨前移(8.3±1.3)mm,双侧下颌矢状劈开和颏截骨前移合计(23.0±2.2)mm。随访时间7.7个月,所有患者 OSAHS 症状均消失,术后 AHI(2.1±1.1)次/h,患者均无语音障碍和吞咽障碍,无明显颌面畸形,牙(牙合)关系良好。结论 UPPP 和 MMA 联合手术治疗 OSAHS 肥胖患者的近期手术效果良好。采用 MMA 同期结合计算机辅助设计的 UPPP 不必然造成腭咽闭合功能障碍;UPPP 与上颌 LeFort-Ⅰ截骨联合手术不必然造成上颌骨缺血坏死或影响上颌创口愈合。

Objective To evaluate the feasibility and the results of the procedure of maxillomandibular advancement combined with uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea hypopnea syndrome（OSAHS）. Methods Nine cases of obese patients with severe OSAHS[ age （47.8 ±9.7） ; body mass index （BMI） （35.3 ±2.5） kg/m^2 ; apnea and hypopnea index （AHI） （88.7 ± 6. 7 ） per laour ] underwent the procedure of maxillomandibular advancement （MMA） combined with uvulopalatopharyngoplasty（UPPP）. The patients were monitored by polysomnography（PSG） before operation and 3,6, 12 months after operation, and cephalometric analysis and velopharygeal closure function were evaluated at the same time. Results The maxilla was advanced by （8.3 ± 1.3 ） mm and the mandible and chin were advanced by （23.0 ±2.2） mm. AHI was （2.1 ± 1.1 ） per hour post-operation. All patients had no speaking problem and swallowing difficulty and had a good appearance and occlusions. The OSAHS in this group of patients was cured. Conclusions Good short-term effects were observed with UPPP and MMA in the treatment of obese patients with severe OSAHS. It did not cause the velopharyngeal closure insufficiency and maxillary necrosis. A long-term follow-up is needed.