重度阻塞性睡眠呼吸暂停低通气综合征的多平面外科治疗

目的：探讨联合应用多个平面手术的方法治疗重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的疗效及临床意义。方法：28例重度OSAHS患者，术前进行明确的阻塞平面定位，根据阻塞平面的不同采取相应的手术方法进行治疗。全部患者在术前、术后6个月及术后1年进行临床随访和PSG监测。结果：手术均未出现严重并发症，术后6个月有效率为100％，1年有效率为89．29％。术后PSG监测示AHI和LSaO2均较术前有明显变化（均P〈0．01）。结论：重度OSAHS患者大多存在上气道多平面解剖结构的阻塞，鼻腔、鼻咽部、腭-咽平面及舌-咽平面阻塞者常见。根据阻塞平面进行多平面手术治疗可提高疗效。手术方案应根据患者上气道阻塞情况和接受程度等具体制定。

Multiple plane operations in treating severe obstructive sleep apnea-hypopnea syndrome

OBJECTIVE: To investigate the effect and clinical value of multiple plane operations in treating severe OSAHS. METHOD: The clinical data of 28 patients with severe OSAHS were retrospectively analyzed. All the patients were performed two planes of operations or more as below: submucous nasal septum resection, nasal sinus endoscopy, adenoidectomy, uvulopalatopharygoplasty (UPPP), tongue base incision, hyoid suspension, tongue base Coblation etc. Operations were finished in the same term or by stages. All patients underwent polysomnography(PSG) examination before operation, and 6-month and 1-year after surgical treatment separately. RESULT: No severe complication occurred, the 6-month, 1-year responders are 100% and 89.29% respectively. Both AHI and LSaO2 changed obviously (P < 0.01). CONCLUSION: Most OSAHS have multi-level obstructions in upper airway caliber, such as nasal, nasopharyngeal, velo-pharyngeal and tongue-pharyngeal obstruction. Multiple plane operations which based on idiographic obstruction sites can improve curative effect. Operation project should be established according to the conditions of upper airway and patients' intention.