多平面手术治疗阻塞性睡眠呼吸暂停低通气综合征疗效评价

Effective evaluation of multiple level surgery in obstructive sleep apnea-hypopnea syndrome

目的探讨多平面手术治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的术后疗效。方法192例经过多道睡眠仪监测诊断为OSAHS的患者行悬雍垂腭咽成形术（UPPP），同期联合鼻中隔偏曲黏膜下切除术者30例，鼻中隔偏曲黏膜下切除术加下鼻甲部分切除术者44例，鼻中隔偏曲黏膜下切除术加舌体部分切除术2例，颏舌肌前徙术加舌体部分切除术者2例，舌体部分切除术3例。伴鼻部疾病和（或）舌体肥大、AHI〉40次／h、LSaO2〈0．64和（或）BMI〉30kg／m^2的患者，术前行气管切开后插管全麻。结果192例患者均行uPPP手术治疗，191例患者术中顺利，1例气管切开时气胸引发呼吸心跳骤停以致术中死亡。术后随访6～37个月，有效132例，有效率68．7％，其中治愈55例（AHI〈50：／h），显效39例（AHI〈20次／h且降低≥50％），有效38例（AHI降低≥50％）；无效印例，无效率31．3％。腭咽＋鼻腔阻塞患者54例、腭咽＋口咽阻塞患者24例、腭咽＋鼻腔＋口咽阻塞患者96例，经单纯UPPP治疗有效率分别为68．2％（15／22）、63．2％（12／19）、55．8％（29／52），总有效率为60．2％（56／93）；经多平面手术治疗患者有效率分别为78．1％（25／32）、5／5、75．0％（33／44），总有效率为77．8％（63／81）。单纯UPPP与多平面手术总有效率比较差异有统计学意义（Χ^2=6．2，P=0．01）。结论多平面手术治疗可以提高OSAHS患者的术后有效率。重度患者采用术前气管切开后插管全麻，能有效的预防手术后严重并发症的发生。

Objective To investigate the therapeutic effects of multiple level surgery in treating obstructive sleep apnea-hypopnea syndrome （OSAHS）. Methods One hundred ninety two patients with OSAHS diagnosed by polysomnography were treated through uvulopalatopharyngoplasty （UPPP）. Thirty patients were combined with sub-mucous resection of the nasal septurn. Forty four patients received sub- mucous resection of the nasal septum and partial inferior turbinectomy. Two patients received sub-mucous resection of the nasal septum and partial resection of the tongue base. Two patients received genioglossus advancement and partial resection of the tongue base. Three patients received partial resection of the tongue base. In addition, the patients with the nasal disease and/or the lingual fat, AHI 〉 40 times/h, LSaO2 〈0. 64 and/or BMI 〉 30 kg/m2 received tracheotomy before general anaesthesia. Results One hundred ninety two patients were treated through UPPP. One hundred ninety one patients were successful, one patient died of pneumatothorax and cardiac arrest during the incision of the trachea. All patients were followed-up for 6-37 monthes, among them, 132 patients showed therapeutic effect, with the effective rate as 68. 7%.Fifty five patients were cured （AHI 〈 5 times/h） ; 39 patients had significant effect （AHI 〈 20 times/h and decreased ≥50% ）; 38 patients were effective （AHI decreased 1≥50% ）. However, 60 patients did not have any therapeutic effect, with the ineffective rate as 31.3%. Fifty four patients had palatopharyngeal and nasal cavity emphraxis, 24 patients had palatopharyngeal and oropharyngeal emphraxis, 96 patients had palatopharyngeal and nasal cavity and oropharyngeal emphraxis. Some patients were treated with UPPP, which made effective rate as 15（68.2% ） ,12（63.2% ） ,29（55.8% ）. The others were treated with multiple level operations, which made effective rate as 25（78.1% ）,5（5/5）,33（75. 0% ）. The effective rate was 60. 2% （ 56/93 ） by simple UPPP and it was 77.8% （ 63/81 ） by multiple level treatment in patients with multiple level obstruction. There was statistical significance between them （ Χ^2 = 6. 2, P = 0. 01 ） . Conclusions The effective rate was improved through multiple level operations in OSAHS patients. The serious complications could be prevented through tracheotomy before general anaesthesia in patients with severe OSAHS who needed multiple level surgery.