咽部重建成形术治疗阻塞性睡眠呼吸暂停的评价与分析

Evaluation and Analysis of Pharyngeal Reconstruction Forming Operation in Treating of Obstructive Sleep Apnea

目的:探讨咽部重建成形术在治疗OSA中,扩大咽部空间和减小咽部塌陷的疗效。方法:咽部重建成形术的基本原则包括扁桃体切除术、去除扁桃体上的粘膜和脂肪组织,把上咽缩肌缝合到前柱来固定咽侧壁,以及把咽腭弓皮瓣头侧缝合到扁桃体上窝以增强软腭强度。结果:术后三个月,没有病人感到吞咽障碍和发音改变。病人恢复正常营养的时间是15天。术后六个月,在打鼾(P=0.005)和白天嗜睡(P=0.008)症状上,有统计学意义上的显著改善。多功能睡眠记录结果显示AHI(P=0.005)和快眼动期显著改善。此外,发现咽部重建成形术术后病人的AHI有所减小。结论:在做过咽部重建成形术(通过增强软腭和固定咽侧壁)的患者中,打鼾和日间嗜睡症状以及不利睡眠呼吸事件和睡眠结构均得到了明显改善,同时也保留了咽部的正常功能。

Objective：To investigate the effects of pharyngeal reconstruction forming operation in treating obstructive sleep apnea,enlarging pharyngeal space,decreasing pharyngeal collapse.Methods： The basic principle of pharyngeal reconstruction forming operation includes tonsillectomy,removing the mucosa and adipose tissue in tonsil,suturing superior constrictor to anterior column in order to fixing lateral pharyngeal wall and suturing palatopharyngeal arch flap euryon to fossa supratonsillaris in qrder to enhance soft palate strength. Results： NO patients feel deglutition disorders and the change of pronunciation after three month of the operation. The time of recovery of normal nutrition is 15 days. There is a significant improvement in the symptom of snoring and daytime sleepiness after six month of the operation. The results of the records of multifunction sleep showed that there is a significant improvement in the apnea hypopnea index and the rapid eye movement. In addition, there is a decreases in the apnea hypopnea index after the pharyngeal reconstruction forming operation. Conclusions： There is a significant improvement in the symptom of snoring and daytime sleepiness, in the sleep structure and events hindered by sleep and respiratory after the pharyngeal reconstruction forming operation（through enhancing soft palate and fixing lateral pharyngeal wall）,The normal function of pharyngeal is also reserved.