改良等离子辅助下的悬雍垂腭咽成形术治疗重度OSAHS

Modified-coblation assisted UPPP in treatment of severe obstructive sleep apnea-hypopnea syndrome

目的：探讨UPPP手术改良的新方法及改良等离子辅助下的UPPP（M-CAUP）治疗重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的疗效。方法：回顾性分析行手术治疗的87例重度OSAHS患者（均经阻塞定位系统ApneaGraph 200监测诊断为腭后区狭窄）。病例选择：术前经PSG结合ApneaGraph 200监测结果示AHI≥30次/h,LSaO2≤85%的患者。M-CAUP手术方法：①70#刀头行双扁桃体被膜外融切术。②70#刀头解剖软腭前间隙,彻底融切软腭前间隙内的脂肪组织,避免损伤腭帆张肌、腭帆提肌及尽量保留悬雍垂肌,保留口咽正常解剖结构。③55#刀头行软腭打孔消融,使软腭适度减容。④成形：缝合以关闭扁桃体窝,腭弓及悬雍垂两侧以丝线间断缝合。术后随访6~18个月并均行PSG。结果：术后患者咽腔扩大,咽腔基本结构完整,无鼻咽反流出现,患者主观症状明显改善。与术前比较,术后AHI值下降、LSaO2升高、Epworth嗜睡量表（ESS）评分下降均有统计学意义（均P〈0.01）。术后有效率为89.7%。结论：OSAHS病因复杂,治疗方法多样,对于重度OSAHS,传统UPPP手术效果多不理想;本研究证实M-CAUP是一种治疗重度OSAHS有效的手术方法,且具有出血少、创伤小及基本保留正常腭咽功能等优点,值得在临床上推广应用。

Objective：To explore a new way to modify the UPPP and to assess the operative efficacy of modified-coblation assisted UPPP（M-CAUP） on patients with severe obstructive sleep apnea-hypopnea syndrome（OSAHS）.Method：A retrospective analysis was made on surgical therapeutic effect of M-CAUP performed in our hospital.Inclusion criteria： 87 adult inpatients with severe OSAHS were involved in the study whose preoperative AHI were beyond 30/h and LSaO2 were under or equal to 85%.All those had the primary level obstruction within the retropalatal region as determined by PSG and airway pressure fluctuation monitoring（ApneaGraph 200,MRA-Medical Ltd,Gloucestershire UK）.The surgical approach of M-CAUP： ①bilateral tonsillectomy by using Arthrocare EVac 70 TA Wand.②dissection of velum palatinum space by using Arthrocare EVac 70 TA Wand,ablation of fat tissue to removed it from the space,avoiding injure levator palatini muscle and tensor palatini muscle and preserving musculus uvula,maintaining the normal structure of oropharynx.③ablation of channel of soft palate by using Arthrocare EVac 55 TA Wand to reduce the volume of soft palate moderately.④plasty： suturing the tonsilar fossa to close the space,interrupted suture two sides of palatine arch and uvula.All patients were followed up for six to eighteen months postoperatively and received PSG.Result：After M-CAUP,the pharyngeal cavity was enlarged while the basic structure of oropharynx was maintained and no nasopharyngeal refluxing occurred.The subjective symptoms were also improved evidently after operation.After operation,the AHI and Epworth sleepiness scale（ESS） decreased while LSaO2 increased.The reduction of AHI and ESS had statistical significance（P0.01）,and the rise of LSaO2 also had statistical significance（P0.01）.The total effective ratio of the operation was 89.7%.Conclusion：Despite of various treatment,the operative efficacy of conventional UPPP was almost not ideal on severe OSAHS due to complex pathogeny.It was proved that M-CAUP was an effectivesurgical treatment of severe OSAHS with less blood loss.The operation was minimally invasive and maintained the normal functions of palatopharynx in principle.It could be applied in clinical practice.