低温等离子辅助软腭外展加折叠术治疗阻塞性睡眠呼吸暂停低通气综合征

目的　探讨腭咽成形术的改良手术方法，在解除腭咽部解剖性狭窄的同时，通过软腭外展增强软腭紧张度，避免睡眠中软腭功能性塌陷，提高手术疗效。方法手术治疗以腭咽部狭窄、软腭松弛为主的阻塞性睡眠呼吸暂停低通气综合征患者55例（重度43例，中度12例），利用软腭两侧斜三角形以及悬雍垂软腭交界处横矩形黏膜瓣切口，在低温等离子刀辅助下，解剖切除双侧腭帆间隙及软腭前方间隙内肥厚黏膜及沉积的脂肪组织，同时行黏膜切缘连同深部肌肉拉拢缝合，缝合后使软腭向两侧外展，悬雍垂-软腭前倾。分别于术前及术后6个月进行Epworth嗜睡量表评分及多道睡眠图监测，对所获得的资料进行统计学分析。结果　55例患者中，治愈8例，显效41例，有效3例，无效3例，手术成功率89.1%。术后Epworth嗜睡量表评分、呼吸暂停低通气指数、最低动脉血氧饱和度与术前比较均有显著性差异（P <0.001）。未出现术后开放性鼻音、长期饮食反流、鼻咽腔瘢痕性狭窄等并发症。结论　低温等离子辅助下软腭外展加悬雍垂-软腭折叠术，使软腭向两侧牵拉外展，悬雍垂及软腭前倾，软腭紧张度增加，可有效解除软腭塌陷，手术疗效满意，无严重并发症发生。

Modified coblation assisted uvulopalatopharyngoplasty for obstructive sleep apnea hypopnea syndrome

OBJECTIVE To investigate the efficacy of modified uvulopalatopharyngoplasty （UPPP） for patients with moderate or severe obstructive sleep apnea hypopnea syndrome （OSAHS）. METHODS Modified coblation assisted UPPP were performed on 55 patients with moderate or severe OSAHS. The main co/lapse sites of the all patients were at the velopharyngeal level. With the assistance of the coblation, the adipose tissue and hypertrophic mucosa of the space yell palatine and the anterior part of the soft palate were removed. The wound was sutured, and that made the soft palate and uvula forward and increased the tension of the soft palate. Epworth sleepiness score was recorded and the polysomnography was took before and 6 months after operation in all of the patients. RESULTS The Epworth sleepiness score and AHI were significantly decreased and the LSO2 was significantly increased after operation （P〈0.001）. There were 8 cases cured, 41 cases improved, and 3 cases unimproved. No serious complications occurred. CONCLUSION The modified UPPP can increase the tension of the soft palate, make the soft palate and uvula forward, and expand the airway behind the soft palate. It is safe and effective.