低温等离子辅助改良腭咽成形联合舌减容和鼻腔扩容术对中重度OSAHS的近期疗效和安全性评价

Modified UPPP with low-temperature plasma tongue volume reduction and selective nasal cavity expansion for moderate to severe OSAHS: short-term efficacy and safety evaluation

目的探讨低温等离子辅助改良悬雍垂腭咽成形术(UPPP)、舌减容联合选择性鼻腔扩容术治疗中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的近期疗效、安全性及临床应用价值等。方法回顾分析淮安市第二人民医院耳鼻咽喉科2013年10月~2016年5月收治的164例中重度OSAHS患者,按手术方式不同分为观察组和对照组,每组82例患者。观察组在充分围手术期准备的基础上,采取低温等离子辅助改良UPPP、舌体舌根减容以及选择性鼻腔扩容术,对照组常规UPPP加鼻腔扩容术进行治疗。比较两组临床疗效、手术并发症情况等指标。结果术后随访6个月,观察组和对照组的总有效率分别为81.7%和62.2%,差异有统计学意义(P<0.05)。随访1年,观察组和对照组的总有效率分别为75.6%和51.2%,差异也有统计学意义(P<0.05)。观察组手术并发症发生率明显低于对照组(P<0.05)。结论对有手术适应证的中重度OSAHS行低温等离子辅助改良UPPP联合舌减容和选择性鼻腔扩容术,可取得较为满意的治疗效果,安全性良好,但术后1年以上的远期疗效有待进一步随访观察。

Objective To explore the clinical efficacy,safety and value of modified uvulopalatopharyngoplasty（ UPPP） versus low-temperature plasma and selective nasal cavity vasodilatation with tongue volume reduction in the treatment of moderate and severe obstructive sleep apnea hypopnea syndrome（ OSAHS）. Methods The clinical data of164 patients with moderate or serious OSAHS treated during Octorber,2013 and May,2016 were retrospective analyzed. According to the different surgical approaches,patients were divided into two groups： the observation group（ n = 82） and the control group（ n = 82）. Patients in the observation group received modified UPPP versus low-temperature plasma and selective nasal cavity vasodilatation with tongue volume reduction,while patients in the control group underwent routine UPPP and nasal cavity vasodilatation. The clinic efficacy,operative complications,postoperative relapse and other indexes of the two groups were compared. Results Six months after surgery,the general effective rate of the observation group and control group was 81. 7% and 62. 2%,respectively,with statistically significant difference（ P〈0. 05）. One year after surgery,the general effective rate of the observation group and control group was 75. 6%and 51. 2%,respectively,with statistically significant difference（ P〈0. 05）. Fewer complications occurred in the observation group than in the control group. Conclusion The efficacy of modified UPPP plus low-temperature plasma and selective nasal cavity vasodilatation with tongue volume reduction can produce satisfactory clinical outcome for patients with moderate or severe OSAHS.