悬雍垂腭咽成形术联合鼻部手术治疗OSAHS疗效分析

目的：探讨悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)联合鼻部手术治疗阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)的临床疗效。方法：所有患者术前均行多导睡眠呼吸监测（polysomonography,PSG）确诊，在行UPPP手术同期行鼻中隔偏曲粘膜下切除术18例，双侧下鼻甲粘膜下部分切除术20例，腺样体切除术2例。其中5例重度患者术前先在局麻下行气管切开，然后在全麻下行UPPP和鼻部手术，其中2例患者选择了气管切开后6～7d再行UPPP和鼻部手术。术后随访1～2年。结果：患者均有不同程度的症状减轻，其中症状基本消失者5例，明显减轻者14例，症状缓解者6例。无术后并发症发生，术后6～13d（平均8.3d）拔除了气管套管。结论：UPPP联合鼻中隔偏曲矫正、下鼻甲部分切除术治疗OSAHS可取得良好的手术疗效，对于重度OSAHS患者，行前置性气管切开术，能够有效预防手术并发症的发生。

Effect of UPPP combined with nasal surgery for patients with obstructive sleep apnea-hypopnea syndrome

Objective: To evaluate the clinical efficiency of uvulopalatopharyngoplasty(UPPP) combined with sub-mucous resection of the nasal septum or inferior turbinate for patients with obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods: All the patients were diagnosed by polysomonography and treated by UPPP.At the same time,sub-mucous resection of the nasal septum was performed on 18 patients,submucous resection of the bilateral turbinate on 20 patients,and adenoidectomy on 2 patients.All of the nasal surgeries were performed by an endoscope. Prophylactic tracheotomy was performed on 5 severe cases.In another 2 cases tracheotomy were performed about 6-7 days before.All the patients were followed up for 1 to 2 years.Results: Symptoms of all the patients were alleviated to some degree: disappeared in 5 patients,reduced in 14 patients,alleviated in 6 patients. No complications occurred.Patients on whom tracheotomies were performed were decannulated in 6-13 days postoperatively.Conclusion: For OSAHS patients,UPPP combined with sub-mucous resection of nasal septum or inferior turbinate could give a better result.For severe OSAHS patients,prophylactic tracheotomy could avoid surgical complications.