阻塞性睡眠呼吸暂停低通气综征手术治疗的临床研究

Clinical study of the surgical treatment on obstructive sleep apnea hypopnea syndrome

目的观察阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)住院患者的手术方式和疗效,探讨如何根据患者病情选择合适的手术治疗方案。方法选择OSAHS患者共40例,根据手术方式不同将患者分为3组,单纯用低温等离子射频消融术辅助下悬雍垂腭咽成形术24例(1组),同时行鼻内镜手术和低温等离子射频消融术辅助下悬雍垂腭咽成形术8例(2组),鼻腔和咽腔分期手术8例(3组)。分别在患者术前和术后3个月行多导睡眠呼吸监测。统计患者的睡眠呼吸暂停低通气指数(Apnea-hypopnea index,AHI)和最低血氧饱和度指标。结果 1组患者中治愈3例,显效15例,,有效6例。2组患者中治愈6例,显效2例。3组分期手术患者首次手术显效2例,有效4例,无效2例。二次手术后治愈6例,显效2例。结论对单纯软腭平面阻塞的患者,低温等离子射频消融术辅助下悬雍垂腭咽成形术疗效显著,同时合并有鼻腔平面阻塞的患者,仅行悬雍垂腭咽成形术手术疗效欠佳,需二期行鼻内镜手术或同时进行两个部位手术。

Objective To explore surgical treatment methods we analyse OSAHS cases of inpatien department. Methods 40 cases underwent 3 different surgical treament methods. According to surgerical methods, 40 cases were divided into 3 groups： low temperature coblation-assisted uvunlopalatopharyng oplasty （first group, 24 cases）, low temperature coblation-assisted uvunlopalatopharyngoplasty and nasal endoscopic surgery at one time （second group, 8 cases）, low temperature coblation-assisted uvunlopalatopharyngoplasty and nasal endoscopic surgery at two times （third group, 8 cases）. Patient charts were reviewed and preoperative and postoperative apnea-hypopnea index 3 months after the surgery （AHI）, minimum oxygen saturation were evaluated. Result In the first group, the effect was successful in 3cases, excellent in 15 cases, good in 6 cases. In the second group, the effect was successful in 6 cases, excellent in 2 cases. In the third group before second operation, the effect was excellent in 2 cases, good in 4 cases and useless in 2 cases. After the second operation, the effect increased to bieng successful in 6 cases, excellent in 2 cases. Conclusions A significantly high operation success rate can be expected after surgical correction with low temperature coblation-assisted uvunlopalatopharyngoplasty for soft palate obstruction after whereas a low operation success rate can be found in the third group before their second operation. Both low temperature coblation-assisted uvunlopalatopharyngoplasty and nasal endoscopic surgery are needed when nasal and palate obstructions are present.