悬雍垂腭咽成形术加舌根手术的临床疗效分析

Treatment result of uvulopalatopharyngoplasty and tongue base operation for the severe obstructive sleep apnea-hypopnea syndrome

目的 探讨应用悬雍垂腭咽成形术及舌根手术治疗腭 咽平面、舌 平面阻塞所致的重度阻塞性睡眠呼吸暂停低通气综合征。方法 对 2 6例经Muller动作检测确定的因腭 咽平面、舌 咽平面阻塞所致的重度阻塞性睡眠呼吸暂停低通气综合征患者进行了悬雍垂腭咽成形术(uvulopalotopharyngoplasty ,UPPP)加舌根手术 ,其中 2 2例采用激光或电刀在舌根正中做菱形或梭形切除 (其中 6例舌根加舌根侧缘切开前固定缝合 ) ,4例单纯舌根侧缘切开前固定缝合。 2例术前做了气管切开术 ,2 0例手术时做了气管切开术 ,全部患者均进行了术前和术后 6个月、1年、3年多导睡眠监测。结果 按照杭州会议疗效评定标准 ,6月内有效率 10 0 0 % ,1年有效率 84 6% ,3年有效率76 9% ,4例患者在 1～ 2年后舌根切除处的凹陷又修复 ,舌根侧缘切开前固定者在术后短期有进食呛咳问题 ,锻炼后顺利进食。结论 对阻塞性睡眠呼吸暂停低通气综合征的患者 ,Muller动作确定阻塞平面是不可缺少的手段 ;UPPP与舌根手术等综合治疗可能会达到更好疗效。行舌根菱形或梭形切除者 。

Objective To study the effect and operative method of UPPP and tongue base operation for the severe OSAHS at Velo -and tongue-pharyngeal obstruction. Methods 26 cases who were diagnosed as severe OSAHS with Velo-and tongue- pharyngeal obstruction by Muller′s maneuver were treated surgically by UPPP and tongue base operation. The tongue base operation included fusiform incision or rhomboid incision in the middle of tongue base by laser or electrotome . 4 cases received tongue base lateral incision and advancement fixation. 2 cases underwent tracheotomy before the operation. 20 cases underwent tracheotomy during operation. Results The 6-month ,1-year and 3-year responders are 100%, 84.6% and 76.9% respectively.The introcession of the tongue base incision were repaired in four cases. After 1-2 years, the cases with lateral incision on the tongue base with advancement fixation had temporary aspiration after the operation and recovered through practice. Conclusion The polysomnography (PSG) was essential to OSAHS and especially to severe OSAHS. Muller′s maneuver is important in locating the obstructive sites of OSAHS.The stitching is essential to the cases after fusiform incision or rhomboid incision of tongue base. The combination of UPPP and tongue base operation is important for OSAHS treatment. The combined treatment of OSAHS could have a better results.