阻塞性睡眠呼吸暂停综合征的外科治疗——腭帆成型与口咽气道扩大

SURGICAL MANAGEMENT OF OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS)-VELOPHARYNGOPLASTY AND OROPHARYNEAL DUCT ENLARGEMENT

手术在保留口咽腔正常解剖形态与功能的前提下 ,解除阻塞、重建并扩大口咽气道。术前经上气道Muller试验证实FujitaI型 5 6 / 6 2例。对 6 2例OSAS施行CO2 激光辅助腭帆成型 ,保留悬雍垂大部或全部 ,切开舌腭弓与咽腭弓 ,松解悬雍垂。术后无鼻咽部粘连及鼻腔反流发生。鼾声基本消失 2 9/ 6 2例 ,明显减轻 30 / 6 2例 ,近期总有效率 95 2 %。本术式基于口咽与腭帆肌群的解剖特点进行设计与重建 ,避免了软腭组织的过多切除 ,可达到明显提升腭帆、扩大口咽气道的目的。

A new surgical technique for the treatment of obstructive sleep apnea syndrome (OSAS) was introduced, especially for those patients with oropharyngeal obstruction. This procedure was intended to relieve the obstruction in oropharynx and enlarge the space of oropharyngeal air duct without destroying its normal anatomical structure and physiological function. In this study Fujita type I was found in 56 of 62 cases by Muller's test. Laser assisted velopharyngoplasty was carried out on all of the patients with preservation of total or part of the uvula. No nasal pharyngeal adhesion or oro nasal cavity backward flow was found after the operation. Snoring disappeared in 29 cases and alleviated in 30 cases with a total effective rate of 95% in all of 62 patients. Our study indicated that based on the constitutional features of oropharyngeal cavity and velopalatal muscles, our surgical design and reconstruction method were able to elevate the venlopalate and, therefore, enlarge the space of the oropharynx effectively.