阻塞性睡眠呼吸暂停低通气综合征的手术治疗:137例临床分析

The surgical treatment of obstructive sleep apnea /hypopnea syndrome:Clinical analysis of 139 consecutive patients

目的:观察不同手术术式治疗阻塞性睡眠呼吸暂停低通气综合征的疗效。方法:对137例(男109例,女28例,年龄6～54岁)阻塞性睡眠呼吸暂停低通气综合征患者,69例采用腭垂腭咽成形术,10例采用腭垂腭咽成形术+舌骨悬吊术,6例采用腭垂腭咽成形术+颏前徙+舌骨悬吊术,9例采用颏前徙+舌骨悬吊术,32例采用正颌手术,11例采用牵张成骨方法进行治疗。结果:术后随访6～60个月,所有患者睡眠打鼾、憋醒、大汗淋漓症状消失或明显改善;129例患者AHI指数由术前51±13降为术后11以下,59例患者AHI指数降为5以下;睡眠时最低血氧饱和度由术前的63%±15%增加至术后的97%±6%,平均血氧饱和度由术前的74%±9%增加至术后的95%±7%,有效率为95%,治愈率为43%。结论:对阻塞性睡眠呼吸暂停低通气综合征患者根据其阻塞部位设计个体化的手术术式,可达到最佳的手术效果。

PURPOSE： To evaluate the curative effect of different surgical methods in treating obstructive sleep apnea/ hypopnea syndrome（OSAS）. METHODS： 137 patient＇s （109 males and 28 females, aged from 6 to 54 years） suffered from OSAHS were treated. Uvulopalatopharyngoplasty （UPPP） was adopted in 69 patients; UPPP with hyoid suspension was adopted in 10 patients. UPPP with advancement genioplasty and hyoid suspension was applied in 6 patients, advancement genioplasty and hyoid suspension was used in 9 patients, orthognathic surgery was adopted in 32 patients, and the technique of osteogenesis was used in 11 patients. RESULTS： The follow-up time ranged from 6 to 60 months. The symptoms of all patients such as snoring, wake up because of stoke and streaming with sweat disappeared or improved remarkahly. The AHI index declined from 51±13 presurgically to below 11 postsurgieally in 129 patients, among them, 59 patients＇ AHI index dropped down to 0-5. While sleeping, their blood oxygen saturation increased from 63%±15% presurgically to 97%±6% postsurgically, and their average blood oxygen saturation increased from 74%±9% presurgically to 95%±7% postsurgically. 8 patients who received UPPP recurred from 3 months to 2 years postsurgieally. The effective rate is 95%, and the cure rate is 43%. CONCLUSION： Applying the specific surgical methods designed according to the obstructive sites, optimal curative effects can be achieved for OSAHS patients.