软腭肌肉部分切除术治疗阻塞性睡眠呼吸暂停低通气综合征的疗效分析

Therapeutic effect of limited palatal muscle resection for obstructive sleep apnea hypopnea syndrome

目的探讨软腭肌肉部分切除术(limited palatal muscle resection,LPMR)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的治疗效果。方法回顾性分析2016年5月~2018年5月经多导睡眠监测(PSG)确诊的92例OSAHS患者,通过上气道压力测定系统(AG200)、上气道CT及光纤内镜检查确诊患者阻塞平面主要位于软腭平面,其中68例患者为悬雍垂腭咽成形术(UPPP)组,开展常规UPPP手术,24例患者为LPMR组,术后6~12个月复查睡眠监测。比较两组手术疗效。结果LPMR组总有效率为91.67%(22/24),其中治愈率25%(6/24),显效率25%(6/24),有效率41.67(10/24)。UPPP组,总有效率为69.12%(47/68),治愈率14.7%(10/68),显效率23.53%(16/68),有效率30.88%(21/68)。LPMR组总有效率明显高于UPPP组(χ~2=0.028,P<0.05)。LPMR组有3例患者术后出现明显鼻腔返流症状,2例存在开放性鼻音,术后1个月复查时症状已消失。两组均无长期并发症存在。结论软腭肌肉部分切除术是治疗阻塞性睡眠呼吸暂停低通气综合征安全、有效的术式。

Objective To investigate the therapeutic effect of limited palatal muscle resection(LPMR)for obstructive sleep apnea hypopnea syndrome(OSAHS).Methods From May 2016 to May 2018,92 patients were diagnosed as OSAHS by polysomnography(PSG).Their obstructive planes were confirmed at soft palate level by Apneagraph 200(AG200),computerized tomography(CT)of upper airway and laryngofiberscopy.According to voluntary option of surgical method,the 92 cases were divided into uvulopalatopharyngoplasty(UPPP)group(n=68)and LPMR group(n=24),and received UPPP and LPMR respectively.At 6 to 12 months after operation,PSG reexamination was performed to all patients and the surgical effect between the two groups was compared and evaluated.Results In the LPMR group,the total effective rate was 91.67%(22/24),including a cure rate of 25%(6/24),a significant effective rate of 25%(6/24),and an effective rate of 41.67%(10/24).And those in the UPPP group were 69.12%(47/68),14.7%(10/68),23.53%(16/68)and 30.88%(21/68)respectively.The total effective rate of the LPMR group was significantly higher than that of the UPPP group(χ~2=0.013,P<0.05).In the LPMR group,nasal regurgitation in 3 cases and open rhinolalia in 2 ceased entirely within one month after surgery.There were no long-term complications in both groups.Conclusion The LPMR is an effective and safe technique for the treatment of OSAHS.