不同术式治疗不同分度扁桃体肿大及重度OSAHS患者的临床分析

Clinical analysis on different surgical procedures for severe OSAHS patients accompanied with tonsillar enlargement of different degrees

目的比较Z型腭咽成形术(Z-uppp)和改良悬雍垂腭咽成形术(H-uppp)对不同分度扁桃体肿大及重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者选择性治疗的临床疗效。方法选择2015年2月~2016年2月收治的有不同分度扁桃体肿大及重度OSAHS患者82例,随机或按患者要求分成两组,其中40例患者采用Z-uppp手术为主的综合治疗,42例患者采用H-uppp手术治疗为主的综合治疗。全部病例术后随访1年,比较其疗效。结果术后1年,38例Ⅰ度扁桃体肿大、重度OSAHS患者Z-uppp术后总有效率为76.5%,H-uppp术后总有效率为35.5%,前者总有效率明显好于后者,经比较差异有统计学意义(P<0.01)。术后1年,44例Ⅱ度及Ⅲ度扁桃体肿大、重度OSAHS患者Z-uppp术后总有效率分别为76.7%、82.9%,H-uppp术后总有效率分别为68.9%、75.5%,两者比较差异无统计学意义(P>0.05)。结论对于Ⅰ度扁桃体肿大、重度OSAHS患者Z-uppp术式长期效果好于H-uppp,而Ⅱ、Ⅲ度扁桃体肿大、重度OSAHS患者两种术式长期效果差异不明显。

ObjectiveTo compare the therapeutic effects of Z-form uvulopalatopharyngoplasty （Z-UPPP） and improved uvulopalatopharyngoplasty （H-UPPP） for patients suffering from severe obstructive sleep apnea-hypopnea syndrome （OSAHS） patients accompanied with tonsillar enlargement of different degrees.Methods82 severe OSAHS patients accompanied with tonsillar enlargement of different degrees hospitalized in our department between Feb 2015 and Feb 2016 were randomly divided into two groups. Of them, 40 cases received comprehensive treatment centered on Z-UPPP, and 42 on H-UPPP. All cases were followed up for one year after surgery, and their results were compared.ResultsOne year after surgery, for the 38 patients with tonsillar enlargement of degree I, the total effective rate of Z-UPPP （n=20） was 76.5%, which was markedly higher than that of H-UPPP （n=18）（35.5%）, and the difference was statistically significant （P〈0.01）. For the 44 cases with tonsillar enlargement of degree II and III, the total effective rates of Z-UPPP （n=10,10） were 76.7%, 82.9% respectively, and those of H-UPPP were 68.9%, 75.5%. The differences were both statistically insignificant （both P〉0.05）. ConclusionsThe long-term effect of Z-UPPP is better than that of H-UPPP for severe OSAHS patients with tonsillar enlargement of degree I, while the differences between the effect of Z-UPPP and H-UPPP for those with tonsillar enlargement of degree II and III are statistically insignificant.