多平面手术联合治疗重度阻塞性睡眠呼吸暂停低通气综合征的临床观察

Evaluation of multi-level surgery for severe obstructive sleep apnea hypopnea syndrome

目的探讨多平面联合手术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法总结了54例患者接受内镜手术、舌骨肌切开悬吊术及舌根减容术等多平面联合术式治疗阻塞性睡眠呼吸暂停低通气综合征并观察患者手术前后的体重指数(BMI)、呼吸暂停低通气指数(AHI)、Ep-worth嗜睡量表评分(ESS)、最低血氧饱和度(LSaO2)、血氧饱和度低于90%的时间占总睡眠时间的百分比(CT90)、悬雍垂长度(UL)、后气道间隙(PAS)等多个生理指标的改变。结果 54例患者均顺利完成手术,除BMI外其他各测量值手术前后比较差异均具有统计学意义(P<0.05)。1例患者术后15 h拔气管麻醉插管时突发窒息立即行紧急气管切开后痊愈;6例患者术后颏下区伤口出现脂肪液化,经对症支持治疗后痊愈;2例患者出现短暂的鼻腔食物反流,1周内消失。所有患者按杭州会议OSAHS疗效评定标准,其中治愈4例,显效28例,有效15例,无效7例,总有效率为87.04%。结论多平面联合术式治疗OSAHS有较好的疗效。

Objective To investigate the surgical effects of multi-level surgery on severe obstructive sleep apnea hypopnea syndrome （ OSAHS ） with multiple level obstruction. Methods 54 patients with severe OSAHS received uvulopalatopharyngoplasty, hyoid myotomy with suspension, tongue volume reduction and endoscopic surgery for nasal cavities. The body mass index （BMI）, apnea-hypopnea index （AHI）, Epworth sleepy scale （ESS）, lowest oxygen saturation （ LSaO2 ） , percentage of sleep time with oxyhemoglobin saturation below 90% （ CT90 ） , uvula length （UL）, posterior airway space （PAS） before and after the operation were detected and compared. Results Operations were performed successfully in all 54 cases. Except BMI, other indexes got obvious changes postoperatively with statistically significant. As for the surgical complications, asphyxia occurred in one patient and got relieved with tracheotomy, submental fat liquefaction in 6 cases and got cured with symptomatic treatment, transient nasal reflux in 2 and fell away within 7 days. According to the Hangzhou criteria of OSAHS, 4 cases got cured, obvious effects occurred in 28 patients, 15 patients were effective, and the total effective rate was 87. 4%. Conclusion UPPP combined with hyoid myotomy with suspension, tongue reduction and nasal endoscopic surgery is effective and safe for the treatment of severe OSAHS.