软腭、舌体低温等离子消融配合H-UPPP治疗重度OSAHS 30例分析

Thirty cases of severe OSAHS treated by combination of H-UPPP and low-temperature plasma of the soft palate and corpus linguae

目的探讨应用改良的悬雍垂腭咽成形术(H-UPPP)配合软腭、舌体低温等离子消融治疗腭-咽平面、舌-咽平面阻塞所致的重度阻塞性睡眠呼吸暂停低通气综合征的可行性、优越性和注意事项。方法对30例经多导睡眠监测,Muller动作检测确定的因腭-咽平面、舌-咽平面阻塞所致的重度阻塞性睡眠呼吸暂停低通气综合征患者进行了改良的悬雍垂腭咽成形术(H-UPPP)配合软腭、舌体低温等离子消融,术中完整保留悬雍垂,切除腭帆间隙脂肪组织,扩大软腭成形范围,并于软腭及舌体低温等离子打孔消融,全部患者均分别进行了术前和术后6个月、1年、3年多导睡眠监测。结果按照杭州会议疗效评定标准,6月内有效率100.00%,1年有效率83.33%,3年有效率76.67%,无1例术中或术后行气管切开术,无1例出现软腭粘连、鼻咽狭窄、大出血、开放性鼻音、死亡。结论对腭-咽平面、舌-咽平面阻塞所致的重度阻塞性睡眠呼吸暂停低通气综合征的患者,软腭、舌体低温等离子消融配合H-UPPP治疗是安全、有效的,具有简单、微创,无需气管切开,愈合快等优点,同时应注意术前应用CPAP治疗,全麻清醒后24 h才拔出气管插管。

Objective To explore the feasibility, superiority and matters for attention of the modified H-UPPP combined with the treatment of low-temperature plasma of the soft palate and corpus linguae for severe OSAHS. Methods 30 cases of severe OSAHS with velo and tongue-pharyngeal obstruction diagnosed by polysomnography and by Muller＇s maneuver were treated surgically by H-UPPP combined with treatment of the low-temperature plasma of the soft palate and corpus linguae. The uvula was preserved completely in the operation and the flat oropharyngeal civility was cut. All the patients accepted polysomnography before the operation, 6-month, 1-year and 3-year after the operation. Results The responses for 6-month, I-year and 3-year were 100%, 83.33%, and 76.67% respectively. No case underwent tracheotomy during and after operation. No velopalatal insufficiency occurred. Conclusions The combined treatment of OSAHS is simple, safe and effective. It needs no tracheotomy and has less injury and rapid recovery. The treatment of CPAP is necessary before operation and the tracheacanula should be removed 24h after waking.