保留扁桃体腭咽成形术治疗特殊解剖类型阻塞性睡眠呼吸暂停患者疗效分析

Therapeutic efficacy oftonsillar preserving H-UPPP for patients with special anatomic type of obstructive sleep apnea

目的探讨保留双侧扁桃体改良悬雍垂腭咽成形术(Han-UPPP,H-UPPP)治疗特殊咽部解剖类型阻塞性睡眠呼吸暂停患者疗效。方法按照纳入标准,选取2014年6月~2018年12月入住我院确诊为阻塞性睡眠呼吸暂停且不耐受持续气道正压通气治疗患者102例。术中随机分为保留双侧扁桃体H-UPPP组和常规H-UPPP组。分析两组术后呼吸暂停低通气指数、最低血氧饱和度及Epworth嗜睡量表评分改善情况,对比患者术后出血比例及疼痛评分。结果保留双侧扁桃体组手术有效率为43.1%(22/51),常规H-UPPP手术组有效率为49%(25/51),无统计学差异(χ^(2)=0.355,P=0.551)。保留双侧扁桃体组无术后活动性出血病例,常规手术组术后有3例活动性出血。保留双侧扁桃体组术后疼痛评分低于常规手术组,差异有统计学意义(P<0.05)。结论对于特殊咽部解剖类型阻塞性睡眠呼吸暂停患者,严格选择性的行保留双侧扁桃体的H-UPPP,在不影响手术疗效的情况下可以明显减轻患者术后疼痛,减少术后咽腔活动性出血,符合加速康复外科理念。

OBJECTIVE To explore the therapeutic efficacy of tonsillar preserving Han-uvulopalatopharyngoplasty(H-UPPP)for patients with special anatomic type of obstructive sleep apnea(OSA).METHODS According to inclusion criteria,102 OSA patients in Renmin Hospital of Wuhan University who can not endure the CPAP treatment were randomly divided into two groups(tonsils-preserved H-UPPP and routine H-UPPP),the clinical trial were performed from Jun.2014 to Dec.2018.ESS scores,AHI,and the LSaO2 before and after operation were compared.The effective rate,postoperative active bleeding rate and VAS pain score were compared between two groups.RESULTS The efficiency of tonsillar preserving H-UPPP group was 43.1%(22/51),while routine H-UPPP was 49%(25/51).There were no significant statistic difference with Chi-square test(χ^(2)=0.355,P=0.551).There was no postoperative active bleeding in tonsillar preserving H-UPPP group,while there were three cases in control group.In addition,the tonsillar preserving H-UPPP group had lower VAS pain score than routine H-UPPP group after operation(P<0.05).CONCLUSION The selective tonsillar preserving H-UPPP not only achieved the similar efficacy compared with routine H-UPPP,but also reduced the postoperative active bleeding and postoperative pain,which enhanced the recovery after surgery.