鼻部手术联合其他平面手术治疗OSAHS疗效分析

Nostril surgeries and other plan surgeries in treatment of obstructive sleep apnea hypopnea syndrome

目的探讨鼻部手术联合其他平面手术（如腭咽平面、舌咽平面手术）治疗阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome,OSAHS）的效果。方法32例患者术前均行多导睡眠呼吸监测（poly-somonography,PSG）确诊,所行鼻部手术包括单纯鼻中隔偏曲黏膜下切除术18例、鼻中隔偏曲黏膜下切除术加单侧下鼻甲黏膜下部分切除术10例、鼻中隔偏曲黏膜下切除术加双侧下鼻甲黏膜下部分切除术2例、鼻中隔偏曲黏膜下切除术加单侧鼻息肉切除加筛窦开放术2例。术中同期联合悬雍垂腭咽成形术（uvulopalatopharyngoplasty,UPPP）26例;UPPP手术、舌根部分切除、舌骨悬吊4例;舌根部分切除、舌骨悬吊2例。32例中2例重度患者行气管切开全麻下行UPPP和鼻部手术、舌根部分切除术,2例因为气管插管和拔除气管套管困难,在手术结束后行气管切开,余28例均在气管插管全麻下进行手术,术后进ICU监护12-24 h,随访1年。结果治愈10例,好转12例,减轻9例,无效1例,所有患者无手术并发症发生。结论鼻部手术联合其他平面手术治疗OSAHS可取得良好效果。对于重度OSAHS或气管插管困难者,术前行气管切开术或手术结束即行气管切开,能有效预防手术并发症的发生。

Objective To investigate the therapeutic effect of nostril surgeries combined with other plan surgeries for obstructive sleep hypopnea syndromes（OSAHS）.Methods Of 32 patients with OSAHS,18 received sub-mucous resection of the nasal septum,10 received sub-mucous resection of the nasal septum and unilateral sub-mucous inferior turbinectomy,2 received sub-mucous resection of the nasal septum and bilateral sub-mucous inferior turbinectomy,and 2 received sub-mucous resection of the nasal septum and unilateral polypectomy and ethmoidotomy.Also 26 patients receiveduvulopalatopharyngoplasty（UPPP）.And 4 patients received combination therapies including nostril surgeries,UPPP,partial resection of the lingual root and suspension of the lingual bone,and 2 received combination therapies including nostril surgeries,partial resection of the lingual root and suspension of the lingual bone.Among 32 patients,2 severe patients received combination therapies under general anaesthesia,2 received a tracheotomy at the end of the operations and the other 28 received the operations under general anaesthesia.All patients received guardianship therapies for 12-24 hours in the ICU after the operations and a follow-up for one year.Results According to the standard of the Hangzhou conference,10 cases were cured,12 cases were improved,9 cases were relieved and 1 case was invalid.No complications occurred.Conclusions Nostril surgeries combined with other plan surgeries can obtain favorable effect for OSAHS.For severe patients,tracheotomy should be performed before or after the operations to prevent complications.