腭帆成形术治疗Ⅱ型OSAHS的综合性疗效评价

Therapeutic efficacy of velopharyngoplasty for type Ⅱ obstructive sleep apnea-hypopnea syndrome

目的探讨腭帆成形术（VPP）治疗Ⅱ型阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的临床疗效。方法选择2008年1月-2012年12月在海军总医院经多导睡眠监测（PSG）确诊为OSAHS的患者128例,其中男113例,女15例,年龄20~64（40.3±10.6）岁。术前确定阻塞平面为软腭平面,行腭帆成形术＋扁桃体切除术,记录术前及术后的Epworth嗜睡量表（ESS）评分、呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSa O2）、体重指数（BMI）和临床症状评分,评估手术前后主观和客观评价指标的变化。结果本组128例患者外科治疗有效率按客观指标（AHI）评价为61.7%（79/128）,按主观指标（ESS评分和临床症状评分）评价分别为85.1%（109/128）和89.8%（115/128）;术后的ESS评分、AHI、LSa O2、临床症状评分与术前比较差异均有统计学意义（P〈0.05）。在AHI降幅〈50%的49例（38.3%）患者中,其术后的ESS评分、LSa O2、临床症状评分与术前比较差异均有统计学意义（P〈0.05）。结论 VPP作为一种改良的悬雍垂腭咽成形术术式,是外科治疗Ⅱ型OSAHS的有效手段。

Objective To explore therapeutic efficacy ofvelopharyngoplasty （VPP） for type II obstructive sleep apnea- hypopnea syndrome （OSAHS）. Methods One hundred and twenty-eight OSAHS patients with the obstructed site located at the soft palate were subjected to VPP and tonsillectomy in Navy General Hospital from January 2008 to December 2012. ESS scores, clinical symptom scores, result of polysomnography including apnea-hypopnea index （AHI）, and the lowest oxyhemoglobin saturation （LSaO2） before and after operation were compared. The subjective and objective evaluation indexes were evaluated. Results The success rate of VPP was 61.7% （79/128） according to subjective evaluation index （AHI） in the series, and 85.1% （109/128） and 89.8% （115/128） according to objective evaluation indexes （ESS score and clinical symptom score）. The ESS scores, clinical symptom scores, AHI and LSaO2 showed statistically significant differences between those before and after operation （P〈0.05）, and in the other 49 patients whose AHI decrease was lower than 50%, the differences in ESS score, clinical symptom score and LSaO2 were also statistically significant between that of pre- and post-operation. Conclusion VPP, as an improved uvulopalatopharyngoplasty, is an effective means in treatment of type II OSAHS.