阻塞性睡眠呼吸暂停低通气综合征患者CT测量上呼吸道狭窄定位诊断的观察

Localization of upper airway stricture by CT scan in patients with obstructive sleep apnea hypopnea syndrome

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者CT测量上呼吸道狭窄定位诊断的临床意义。方法采用螺旋CT自鼻咽顶部到声门之间的区域进行连续扫描,应用图像工作站测量软腭后区、悬雍垂区、舌后区和会厌后区的气道横截面积和各径线长度以及咽侧壁和咽后壁软组织厚度等指标,选取88例健康人测量数值确立正常值范围。测量82例OSAHS患者上呼吸道CT扫描的结果并与相应解剖区的正常值比较。结果 82例OSAHS患者中,仅有1个平面狭窄者17例,其中为软腭后区狭窄者5例,悬雍垂区狭窄者4例,舌后区狭窄者6例,会厌后区狭窄者2例。相邻的两个解剖区域共同狭窄45例,其中为软腭后区及悬雍垂区者26例,悬雍垂区及舌后区者15例,舌后区及会厌后区者4例。软腭后区、悬雍垂区和舌后区3个解剖区域共同狭窄20例。同时对88例健康人清醒状态下上气道4个平面截面积做测量分析,结果显示截面积软腭后区最为狭小,其次为舌后区,而会厌后区截面积最大。OSAHS组软腭长度及厚度均大于正常组,提示软腭增长、增厚是咽腔狭窄的原因之一。结论大部分OSAHS患者存在上呼吸道的解剖性狭窄,上呼吸道的CT扫描测量可以较好的确定具体狭窄部位,针对性手术治疗便于提高临床疗效。

Objective To evaluate the clinical significance of CT scan in the localization of upper airway stricture in patients with obstructive sleep apnea hypopnea syndrome （ OSAHS）. Methods Multi-slice spiral CT was adopted in continuous scanning manner to evaluate the region from top of nasopharynx to glottis. With district apply image workstation, the cross-sectional areas and lengths of their path lines at the level of soft palate, uvula, tongue and epiglottis were measured. Meanwhile, the thicknesses of their lateral and posterior walls were detected. In this study, 88 health adults were included to establish the normal ranges of above-mentioned parameters. The results obtained from 82 OSAHS patients were compared with those from the normal controls. Results Of all the 82 OSAHS patients, one stricture site was detected in 17 cases： retro-palatal stenosis in 5 cases, retro-uvula stenosis in 4, retroglossal stenosis in 6, and retro-epiglottic stenosis in 2.45 patients had two adjacent stricture sites including combined retro-palatal stenosis and retro-uvula stenosis in 26 cases, retro-uvula stenosis and retroglossal stenosis in 15, retroglossal stenosis and retro-epiglottic stenosis in 4. Combined retro-pallatal stenosis, retro-uvula stenosis and retroglossal stenosis were detected in 20 patients. Detection of minimal mean cross-section areas of upper airway of 88 health adults in waking revealed the minimal cross-section area at retro-uvula level followed by retroglossal level, and maximal cross-section area at retro-epiglottic level. The length and thickness of soft palate in OSAHS group were greater than those in the control group respectively, which suggested that the lengthening and thickening of soft palate might be the causes of pharyngeal stricture. Conclusions Anatomic stricture of upper airway might occur in most OSAHS patients. Multi-slice spiral CT can localize the upper airway stricture accurately, which facilitates improvement of therapeutic effect on the specific surgical treatment for OSAHS.