同期鼻腔扩容术联合改良悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征

Nasal cavity expansion simultaneously combined with Han-uvulopalatopharyngoplasty for obstructive sleep apnea hypopnea syndrome

目的探讨鼻腔扩容术同期联合改良悬雍垂腭咽成形术（Han—uvulopalatopharyngoplasty，H．UPPP）治疗阻塞性睡眠呼吸暂停低通气综合征（obstructivesleepapneahypopneasyndrome，OSAHS）的疗效。方法多道睡眠图（polysomnography，PSG）监测及临床检查确诊的OSAHS且阻塞平面为鼻腔及腭咽腔患者132例，同期行鼻腔扩容术和H．UPPP，术后6个月～1年复查PSG监测，观察联合手术治疗的效果。结果成功随访108例患者，有效率为83．33％（90／108），术后患者夜间平均动脉血氧饱和度、血氧饱和度低于90％的时间占总睡眠时间的百分比、最低动脉血氧饱和度、Epworth嗜睡量表4个指标均较术前有明显改善（P〈0．01）；术后发生2例鼻腔出血，1例扁桃体窝出血，7例鼻腔粘连，未发生其他并发症。结论对存在鼻腔及腭咽腔平面狭窄的OSAHS患者，同期行鼻腔扩容联合H-UPPP，安全有效，可以作为此类患者的首选手术治疗方式。

OBJECTIVE To explore the efficacy and indications of the selective expansion of the nasal cavity simultaneously combined with Han- uvulopalatopharyngoplasty （H-UPPP） in treatment of obstructive sleep apnea hypopnea syndrome （OSAHS） . METHODS 132 patients suffered form obstructive sleep apnea syndrome diagnosed by polysomnography and clinical sign, whose obstructive site lied in nasal and pharyngeal cavity. All patients underwent nasal surgery expansion plus uvulopalatopharyngoplasty surgery. Six months to 1 year after operation, following -up was taken with polysomnography. RESULTS 108 patients were successfully followed-up. The efficiency was 83.33% （90/108） . Postoperative mean nocturnal SaO2, the proportion of time of oxygen less than 90% in total sleep, lowest pulse oxygen saturation （LSaO2） and Epworth sleepy scale （ESS） score were obviously improved （P〈0.01） ; The postoperative severe complication was never happened except 2 nasal bleeding, 1 tonsil bleeding and 7 nasal adhesions. CONCLUSION Simultaneous endoscopic nasal dilation combined with uvulopalatopharyngoplasty was safe and valid for OSAHS patients with nasal and pharyngeal obstruction. The surgical program can be used as the preferred treatment for these patients.