悬雍垂腭咽成形术失败再次手术治疗的研究

Investigation of reoperation after failure of UPPP

目的:通过对悬雍垂腭咽成形术(UPPP)治疗失败的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者施行再次手术,探讨UPPP失败再次治疗的手术方式。方法:回顾性分析15例UPPP治疗失败的OSAHS患者的诊治过程,分析并针对具体初次手术失败的原因,采用改良半导体激光或等离子射频辅助下的腭咽成形术、软腭切开前移术等术式结合舌及软腭等离子射频消融术进行再次治疗。1年后随访及进行PSG等检查。结果:术后1年复查,AHI值由(38.56±11.23)次/h降低至(4.87±1.59)次/h,差异有统计学意义(t=13.15,P<0.01)。最低血氧饱和度由术前的(61.5±8.5)%升高至术后的(79.9±9.7)%,差异有统计学意义(t=10.2,P<0.01)。一次性治愈率为93%(14/15),总有效率为100%(15/15)。无手术并发症发生。结论:术前对患者阻塞原因及部位判断不明确,手术方式选择不当,手术方案单一,手术技术不成熟及术中操作粗暴等为UPPP失败的常见原因,针对不同的病例制定个体化的手术方案,等离子射频等技术可弥补UPPP的不足且可使UPPP更微创、简便易行。

Objective：To explore the surgerical ways of reoperation of the UPPP. Method： Fifteen failed cases of OSAHS after UPPP were reviewed and analyzed. The reoperations were performed with modified laser assistant,ablation assistant UPPP combining ablation of tongue base. The follow-up was done after 1 year. Result： The AHI decreased from（38.56±11.23）/h to （4.87±1.59）/h and the lowest SpO2 increased from （61.5±8.5）% to （79.9± 9.7）% of the patients. The statistical difference was significant（P〈0.01） in 1 year after the reoperation. The total validity ratio was 100% and the recovery rate was 96%. No complications happened. Conclusion：The shortcomings of UPPP could be made up with ablation ,and the ablation could help the UPPP more minimal damage and effective therapy.