倒刺线软腭咽侧悬吊咽成形联合改良悬雍垂腭咽成形术治疗OSAHS患者疗效分析

Efficacy of Barbed reposition pharyngoplasty combined with Han-Uvulopalatopharyngoplasty for the treatment of OSAHS patients

目的研究倒刺线软腭咽侧悬吊咽成形术(Barbed reposition pharyngoplasty,BRP)联合改良悬雍垂腭咽成形术(Han-Uvulopalatopharyngoplasty,H-UPPP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者外科手术疗效。方法回顾性分析2021年6月—2022年2月入住武汉大学人民医院耳鼻咽喉头颈外科,符合研究入组标准的OSAHS外科手术患者资料。按照手术方式分成2组:单纯H-UPPP手术组[对照组,47例,其中男42例,女5例,年龄18~64(37.77±11.65)岁]和H-UPPP+BRP联合手术组[研究组,48例,其中男45例,女3例,年龄23~60(39.10±9.86)岁]。分析2组患者术后6个月手术有效率以及改良Friedman咽部解剖分型与2组患者手术疗效的关系;比较2组患者术后3 d疼痛视觉模拟评分(visual analogue scale,VAS)以及术后6个月咽部异物感发生率。采用SPSS 23.0软件进行统计学分析。结果2组患者术前性别、年龄、体质量指数(BMI)、Friedman分型及Epworth嗜睡量表(Epworth Sleepiness Scale,ESS)评分、睡眠呼吸暂停低通气指数(AHI)、最低脉搏氧饱和度(lowest oxygen saturation,LSpO_(2))的差异均无统计学意义(P>0.05)。2组血氧饱和度低于90%累计时间占总睡眠时间比(ratio of cumulative time of oxygen saturation below 90%to total sleep time,CT90)比较差异有统计学意义(Z=2.29,P=0.022)。手术有效率方面,H-UPPP组为48.9%(23/47),H-UPPP+BRP组为70.8%(34/48),2组差异具有统计学意义(χ^(2)=4.74,P=0.029),H-UPPP+BRP联合手术组较单纯H-UPPP手术组在Friedman咽部解剖分型Ⅱb(87%vs.61.9%)及Ⅲ型(44.4%vs.15%)患者中似乎有更高的手术有效率,但差异无统计学意义(P>0.05)。与单纯H-UPPP手术组相比,H-UPPP+BRP组术后3 d疼痛VAS评分较高(t=-3.10,P=0.003),术后6个月咽部异物感发生率较高(χ^(2)=4.73,P=0.030)。结论在OSAHS患者外科手术治疗中,BRP联合H-UPPP手术整体有效率高于单独的H-UPPP手术,可能更适合于Friedman咽部解剖分型中Ⅱb和Ⅲ型患者。

Objective To study the efficacy of Barbed reposition pharyngoplasty(BRP)combined with Han-Uvulopalatopharyngoplasty(H-UPPP)in surgical treatment of OSAHS patients.Methods OSAHS patients admitted to our department from June 2021 to February 2022 who met the surgical enrollment criteria were divided into two groups by surgical procedure:H-UPPP operation group[Control group,47 cases,including 42 males and 5 females,aged 18-64(37.77±11.65)years,and H-UPPP+BRP group[Study group,48 cases,including 45 males and 3 females,aged 23-60(39.10±9.86)years].The surgical efficacy 6 months after operation was retrospectively analyzed.Meanwhile,the relationship between the surgical efficacy and modified Friedman pharyngeal anatomical stages was analyzed.The postoperative pain VAS score at first 3 days and the incidence of foreign body sensation in pharynx after 6 months of operation were compared between the two groups.Statistical analysis was conducted by SPSS 23.0.Results There were no significant differences in gender,age,BMI,Friedman pharyngeal anatomical stages,ESS score,AHI and LSpO_(2)between the two groups,preoperatively(P>0.05).There was significant difference between the two groups in ratio of cumulative time of oxygen saturation below 90%to total sleep time(CT90),preoperatively.Surgical efficacy of H-UPPP operation group was 48.9%(23/47),while H-UPPP+BRP operation group was 70.8%(34/48),which was statistically significant(χ^(2)=4.74,P=0.029).H-UPPP+BRP group seemed to have a higher surgical efficacy than H-UPPP group in patients with FriedmanⅡb(87%vs.61.9%)andⅢstage(44.4%vs.15%),but there was no statistically significant difference(P>0.05).H-UPPP+BRP group had a higher pain VAS score in first three days(t=-3.10,P=0.003),also had higher incidence of pharyngeal foreign body sensation after 6 months of operation(χ^(2)=4.727,P=0.030).Conclusions In the surgical treatment of OSAHS patients,the overall efficacy of BRP combined H-UPPP surgery is higher than that of H-UPPP surgery alone.It may be more suitable for OSAHS patients with modified Friedman typeⅡb and typeⅢstage.