切除部分腭咽肌的改良UPPP术后疗效观察

The clinical investigation of the potential complications of H-UPPP surgery in removing the partial pharyngeal muscle

目的:为了提高改良UPPP术后疗效,术中切除部分腭咽肌,并对术后疗效、咽腔成形特点及可能出现的并发症等进行临床观察。方法:选择经Apneagraph睡眠呼吸监测阻塞定位仪(AG)、纤维鼻咽喉镜结合Müller检查及鼻咽部3D-CT确诊的OSAHS患者82例,随机分为对照组26例,于全身麻醉下行传统的改良UPPP术,术中不切除部分腭咽肌;实验组56例,于全身麻醉下行改良UPPP术,术中切除部分腭咽肌。术后半年内每个月通过复查或电话随访的方式了解患者是否出现鼻腔反流、耳闷及听力下降等并发症。术后6个月采用嗜睡程度评估量表(ESS)评价嗜睡状态,应用t检验与术前ESS评分进行统计学对比分析。术后6个月应用AG评价疗效。通过测量悬雍垂长度(L1)、软腭游离缘与咽后壁距离(L2)及鼻咽峡宽度(L3)了解咽峡成形结构特点,应用多元线性回归分析进行假设检验并评价各测量值与疗效的关系。用SPSS19.0软件进行数据分析。结果:术后6个月实验组显效50例(89.29%),有效6例(10.71%);术前ESS评分11.74±2.48,术后3.84±2.05。对照组显效19例(73.08%),有效7例(26.92%);术前ESS评分11.91±2.40,术后6.92±2.47,两组疗效差异有统计学意义(P<0.01)。术后半年内两组均未见耳闷、听力下降、自家音增大等反映咽鼓管功能障碍的并发症,半年后两组咽腔功能均恢复正常。术后6个月实验组和对照组L1分别为(5.91±3.38)mm和(6.20±3.76)mm(P>0.05);L2分别为(15.70±3.29)mm和(15.35±1.44)mm(P>0.05);L3分别为(20.54±3.33)mm和(16.43±2.21)mm(P<0.05),说明实验组的术后L3明显增宽。通过多元线性回归分析,术后疗效与L2手术前后的差值和L3手术前后的差值有线性回归关系,并与二者呈负相关。由标化回归系数看出,L3手术前后的差值对术后疗效影响最大。结论:切除部分腭咽肌的改良UPPP通过有效增加术后鼻咽峡宽度提高了手术疗效,并且术后未出现咽鼓管功能、软腭功能、吞咽功能及构音功能障碍。

Objective：In order to improve the postoperative effect of modified UPPP,removing the partial pharyngeal muscle in surgery,we investigate the postoperative effect,the characteristics of pharyngeal cavity and the potential complications in OSAHS patients.Method：To choose 82 OSAHS patients with obstructive oropharyngeal plane diagnosed by Apneagraphy（AG）,Fibre nasopharyngoscope combined with Müller examination and nasopharyngeal 3D-CT,which had completed clinical data inpatients in the anesthesia underwent of the partial pharyngeal muscles in the postoperative,divided into a control group of 26 cases,operating the H-UPPP surgery which did not remove partial pharyngeal muscle;The experimental group of 56 cases did a H-UPPP surgical which removed partial pharyngeal muscle of possible concurrent symptoms such as nasal regurgitation,Eustachian tube dysfunction and other follow-up study in six months after the monthly telephone follow-up or outpatient exams to understand the disease.Patients were evaluated the sleepiness by ESS（Epworth sleepiness scale） in 6 months after the surgery,compared with the preoperative ESS scores,do a t test for statistical analysis.AG can be used to evaluate effects of the UPPP after 6 months.By measuring uvula length（L1）,extent from free edge of soft palate to postpharyngeal（L2） and stenosis of nasopharynx width（L3） mean,we investigate the characteristics of pharyngeal cavity using the multiple linear regression to do the hypothesis test and evaluate the association between meas uring mean and effect.Using SPSS19.0 software do the preoperative contrast analysis.Result：After 6 months in surgery,56 cases in the experimental group,effect in 50 cases（89.29%）,effective in 6 cases（10.71%）;ESS score：Preoperative 11.74±2.48,after the first 6months 3.84±2.05.Twenty-six cases in control group,effect in 19 cases（73.08%）,effective in 7 cases（26.92%）;ESS score： Preoperative 11.91±2.40,after the first 6 months 6.92±2.47,t-test P value of less than 0.05 between the experimental group and the control group;There are no ear fullness,hearing loss,increase their own sound which reflect eustachian tube dysfunction and other complications in two groups;The function of pharyngeal cavity could be recoveried normal lever after 6 months;After 6 months of the operation,in the experimental group and the control group L1 mean was respectively（5.91±3.38）mm and（6.20±3.76）mm（P〉0.05）;L2 mean was respectively（15.70±3.29）mm and（15.35±1.44）mm（P〉0.05）;L3 mean was respectively（20.54±3.33）mm and（16.43±2.21）mm（P〈0.05）.Nasal fauces pitch mean was significantly widened.By the multiple linear regression analysis,the postoperative effect has the linear correlation between L2 and L3 residual mean with the negative correlation.Due to the standardized coefficient,L3 residual mean has the most influence on the postoperative effect.Conclusion：Modified UPPP surgery removing the partial pharyngeal muscle is in favor of upgrading the postoperative effect with significantly increasing the width of postoperative nasal pharyngeal isthmus area,then there are not occur the eustachian tube dysfunction,the soft palate function,swallowing and articulation function disabled.