螺旋CT在诊断阻塞性睡眠呼吸暂停低通气综合征患者咽部阻塞平面中的应用

Diagnosis of obstructive level in pharynx with obstructive sleep apnea hypopnea syndrome with multiple detector-row spiral CT

目的:探讨螺旋CT扫描对阻塞性睡眠呼吸暂停低通气综合征(OSHAS)患者咽部阻塞平面的诊断意义。方法:采用螺旋CT对自鼻咽顶部到声门之间的区域进行连续扫描,测量鼻咽区、口咽区、喉咽区及咽腔最狭窄区的咽腔横截面积和前后径、左右径以及咽壁厚度等指标。通过67例中、重度OSAHS患者(OSAHS组)CT资料相关指标的测量,并与40例健康者(对照组)的CT资料进行比较。结果:①OSAHS组患者CT资料显示,口咽部截面积、左右径、前后径分别(133.5±32.9)mm2、(12.5±2.0)mm、(10.4±1.8)mm,对照组的相关数据分别为(238.5±46.5)mm2、(20.4±3.1)mm、(21.1±4.0)mm,2组数据比较差异有统计学意义。②67例OS-AHS组患者,有61例(61/67)出现最狭窄平面,其中位于口咽区者58例,鼻咽区者3例,未见喉咽区明显狭窄平面。58例口咽区出现最狭窄平面中,在舌后区占48.5%(28/58)、软腭区域占32.8%(19/58)、悬雍垂区域占19.0%(11/58);对照组中24例(24/40)出现最狭窄平面,该平面均在口咽区。③58例口咽区存在最狭窄平面者,其截面积、左右径、前后径分别为(75.6±17.9)mm2、(10.6±2.1)mm、(6.9±1.0)mm;而对照组的最狭窄平面相关数据分别为(187.3±35.6)mm2、(21.4±4.3)mm、(15.6±2.7)mm,2组比较差异有统计学意义。结论:咽部螺旋CT扫描可较好地判断OSAHS患者的具体狭窄平面,大部分OSAHS患者存在咽腔解剖性狭窄,主要狭窄部位在口咽区。

Objective：To evaluate the diagnostic significance of multiple detector-row spiral CT（MSCT） in patients with obstructive sleep apnea hypopnea syndrome （OSAHS）. Method： Sixty seven patients with OSAHS and 40 volunteers were scanned. The CT imagings from the nasaopharyngeal floor to the glottis obtained. The relevant dimensions of area, diameter, thickness of retropharyngeal tissue were measured in some regions in imagings in cluding nasaopharynx, oralopharynx and hypopharynx, as well as the narrowest region in pharynx. Result： ①The values of area, left-right diameter and front-back diameter of oralopharyngeal imagings of patients with OSAHS werenarrowest regions which were （133.5±32.9）mm^2,（12.5±2.0）mm,（10.4±1.8）mmrespectively. The value of above parameters of oralopharyngeal imagings of volunteers were （238.5 ± 46.5 ） mm^2, （20.4 ± 3.1 ）mm, （21. 1±4.0）mm respectively . The values of two groups had marked difference by statistics（P〈0.01）. ②The narrowest regions were located in oraopharynx in the imagings of 58 patients with OSAHS, which located in soft palate site in 19 patients, in oralopharynx site in 11 patients and in retro-lingua site in 28 patients. The narrowest regions were located in nasaopharynx in the imagings of 3 patients. None of the narrowest rigion was found in hypopharynx. The narrowest regions, which all located in oralopharynx, were measured in the imagings of 24 volunteers. ③ The values of area, left-right and front-back diameter of the narrowest regions of imaging of 58 patients with OSAHS among 67 patients were （75.6±17.9） mm^2,（10.6±2.1）mmm,（6.9±1.0）mm respectively. The values of bove parameter of the most narrowest regions of imagings of volunteer were （187.3±35.6） mm^2, （21.4 ±4.3）mm,（15.6±2.7）mm respectively. There were significant difference in statistics among the data of these groups （P〈0.01）. Conclusion： The imagings of MSCT may provide accurate diagnosis in OSAHS. Patients with OSAHS always had anatomically narrow in pharynx, especially in oralopharynx.