阻塞性睡眠呼吸暂停低通气综合征术后复发原因分析及再手术治疗研究

Research on failure reasons of surgical treatment of obstructive sleep apnea hypopnea syndrome and reoperation method

目的:分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)手术治疗后复发的原因,探讨再手术治疗的方案及疗效。方法:选择首次手术治疗后复发的OSAHS患者27例,行便携睡眠监测阻塞定位仪(AG)睡眠监测、电子鼻咽喉镜检查及Müller试验、鼻咽3D-CT。对其中入院再次接受手术治疗的14例患者针对不同阻塞平面,行改良UPPP、鼻腔扩容术、鼻咽部腺样体切除术、舌体部分切除术、气管切开术。术后半年AG睡眠监测、并发症观察,术前术后Epworth嗜睡量表评分。结果:术后半年AHI由(48.19±13.11)次/h降至(11.32±4.42)次/h,嗜睡量表评分由(12.93±4.60)分降至(4.93±1.44)分,均P<0.05。治愈2例,显效12例。术后无呼吸困难、出血、进食反流等并发症。结论:判定阻塞平面和选择适合的术式是提高疗效的关键,术前AG睡眠监测、鼻咽3D-CT、电子鼻咽喉镜检查对于判定阻塞平面、决定术式具有重要意义。

Objective：To analyze failure reasons of surgical treatment of obstructive sleep apnea hypopnea syndrome（OSAHS）,and explore the methods of reoperation.Method：By selecting 27 patients,who accepted surgical treatment for OSAHS and recurred,we analyzed failure reasons and obstructive location by apneagraph,nasopharyngeal 3D-CT,electronic nasopharynlaryngoscope.Among them,14 patients accepted reoperation,such as uvulopalatopharyngoplasty（UPPP）,nasoendoscopic surgery,adenoidectomy,partial glossectomy,tracheotomy were applied matching to differential obstructive location.AHI,lowest SaO2,Epworth sleepiness scale（ESS）,complication were recorded after 6 months.Result：After 6 months,their AHI decreased from 48.19±13.11 to 11.32±4.42,ESS scores decreased from 12.93±4.60 to 4.93±1.44,P〈0.05.Two of the 14 patients were cured,while the other 12 were efficient.No complications were observed.Conclusion：Obstructive location judgement and proper surgical operation are the keys of the treatment.Preoperative AG sleep monitoring,nasopharyngeal 3D-CT,electronic nasopharynlaryngoscope examination for determining blocking plane,the decision of surgery which is significantl.