多平面分期手术治疗重度阻塞性睡眠呼吸暂停低通气综合征的临床疗效探讨

The clinical effect of multiple plane staging operations on severe obstructive sleep apnea-hypopnea syndrome

目的探讨多平面分期手术治疗重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床疗效。方法选取26例确诊的OSAHS患者进行多平面分期手术。Ⅰ期手术:均行双侧或单侧下鼻甲黏骨膜下部分切除术,摘除部分下鼻甲骨,13例合并鼻中隔偏曲患者同时行鼻中隔矫正术,3例合并单侧鼻息肉、同侧上颌窦、筛窦炎患者同时切除鼻息肉,开放上颌窦和筛窦;Ⅱ期手术:单纯行H-UPPP手术16例,同期联合硬腭截短软腭前移术2例,同期联合舌骨悬吊术8例。观察手术前后呼吸暂停、打鼾症状改善情况,AHI、LSaO2、平均SaO2、ESS评分变化以及术后并发症情况。结果术后所有患者呼吸暂停、打鼾症状均消失或不同程度减轻,术后6个月及术后1年AHI、LSaO2、平均SaO2、ESS评分较术前均有明显改善(P<0.01),所有患者术后均无需行气管切开术。结论根据阻塞平面进行多平面分期手术治疗重度OSAHS患者可提高疗效,并能有效避免围手术期行气管切开术,减少了手术并发症。

Objective To investigate the clinical effect of multiple plane staging operations on severe OSAHS.Methods Twenty-six patients with severe OSAHS were selected.In the first stage operation,all patients received unilateral or bilateral sub-mucous inferior turbinectomy,13 patients with deflection of nasal septum received nasal septum construction simultaneously,and 3 patients with unilateral rhinopolypus,maxillary sinusitis and ethmoiditis received polypectomy,maxillary sinusotomy and ethmoidotomy simultaneously.In the second operation stage,16 patients received simple H-UPPP,2 patients simultaneously received hard palate shortening,and 8 patients simultaneously received suspension of the lingual bone.The symptoms of apnea and snore,the improvement of AHI,LSaO2,average SaO2,ESS and operation complications were observed.Results The symptoms of apnea and snore were improved,and AHI,LSaO2,average SaO2,ESS after-operation were significantly improved than that of pre-operation（P0.01）.Tracheotomy was not performed after the operations.Conclusion The multiple plane staging operations on severe OSAHS can improve curative effect based on idiographic obstruction sites.Tracheotomy needn′t to be performed before or after the operations to prevent complications.