CT术前评估中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)悬雍垂腭咽成形术(UPPP)的远期疗效

The study of 64-slice CT preoperative evaluation on long-term efficacy of uvulopalatopharyngoplasty(UPPP)in moderate or severe obstructive sleep apnea hypopnea syndrome(OSAHS)

目的探讨64排螺旋CT扫描对中重度阻塞性唾眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome, OSAHS）患者悬雍垂腭咽成形术（uvulopalatopharyngoplasty, UPPP）术前评估远期疗效的价值，以提高中重度OSAHS患者UPPP远期疗效的方法。方法38例经多导睡眠图确诊的中重度OSAHS患者经过UPPP术前64排螺旋CT在平静呼吸相和Muller相两种状态下上气道三维重建及虚拟内窥镜处理后，根据各平面截面积的变化值分为3组，随访20-30个月，比较各组之间UPPP远期疗效、术前术后CT各测量值的变化，分析两者之间的相关性，探索UPPP最佳适应证。结果实验1组有效率100％、显效率83．33％、治愈率16．67％，实验2组有效率77．78％、显效率55．56％、治愈率11．1％，与1组的差异有统计学意义。实验3组有效率50％、显效率20％、治愈率为0，明显比1组、2组疗效下降。实验1组平静呼吸相和Muller相从鼻咽后区至舌根后区截面积的改善值与睡眠呼吸暂停低通气指数呈线性相关，最低动脉血氧饱和度改善值也与部分平面截面积的改善值呈线性相关。结论64排螺旋CT术前扫描对中重度OSAHS患者UPPP术前评估远期疗效具有重要价值，对于Muller相软腭后区或悬雍垂后区截面积较平静呼吸相减少≥75％或完全闭塞，且舌根后区、会厌后区、鼻咽后区截面积减少≤50％的患者，UPPP远期疗效好。

Objective To investigate the value of 64-slice CT preoperative evaluation on long-term efficacy of uvulopalatopharyngoplasty （UPPP） in moderate or severe obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods Thirty-eight patients with moderate or severe OSAHS were measured by 64-slice CT in quiet breathing and in Muller maneuver. After three-dimensional reconstruction and virtual endoscope handing of the upper airway, all cases were divided into 3 groups according with the change value of cross-section area of the upper airway. After 20 to 30 months,we analyze the efficacy of UPPP, and study the change of various CT measure values and their relationships.Results In the 1st,2st and 3st, experimental groups,effective rate were 100% ,77.78% ,50% ,excellent rate were 83.33% ,56.56% ,20% ,and curative rate were 16. 67% ,11.1% ,0 respectively. UPPP in the 3rd group was not as effective as it was in the 1st and 2nd groups. In the 1st group, there was linear correlation between the improvement value of cross section area of the upper airway and AHI,and also between the improvement values of cross-section area and the lowest arterial oxygen saturation （S, O2） improvement value. Conclusions Three-dimensional reconstruction and virtual endoscope of 64 slice CT is significant to predicting long-term efficacy of UPPP in moderate and severe OSAHS. If cross- section area of retro palatal or uvula region decreases above 75%, and cross-section area of retroglossal, epiglottis and nasopharynx region decreases below 50% in Muller maneuver, the long-time efficacy of UPPP is excellent.