等离子刀腭咽成形术联合舌骨悬吊术治疗重度阻塞性睡眠呼吸暂停综合征36例

目的:探讨等离子刀腭咽成形术联合舌骨悬吊术治疗重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法:36例重度OSAHS患者,经电子鼻咽喉镜检查结合Müller试验、头影测量分析及上气道CT检查确定存在腭咽及舌咽平面阻塞。均于术前先行经鼻持续正压通气治疗5～7d,然后同期行等离子刀腭咽成形术联合舌骨悬吊术。采用Wilcoxon符号秩和检验分析手术前后各相关参数的变化。结果:术后随访6～24个月,除体质指数外,手术前后各相关测量值的变化均具有统计学意义(P<0.05)。呼吸紊乱指数从63.83±16.34下降到21.43±20.34,LSaO2从(72.44±7.07)%上升至(81.33±13.32)%。按杭州会议标准:治愈2例,显效22例,有效8例,无效6例,总有效率为83.33%。结论:等离子刀腭咽成形术联合舌骨悬吊术是目前治疗腭咽及舌咽平面阻塞的重度OSAHS患者的一种有效的手术方案。

Hyoid suspension plus coblation assisted uvulopalatopharyngoplasty for severe OSAHS :a report of 36 cases

Objective:To explore the effects of hyoid suspension plus coblation assisted uvulopalatopharyngoplasty (CAUP) on the treatment of severe obstructive sleep apnea hypopnea syndrome. Methods:ThirtySixth patients with severe OSAHS (RDI>40)were diagnosed by polysomnography.The obstruction in boththe oropharynx and the hypopharynx were determined by preoperative physical examination,fiberoptic pharyngo-laryngoscopy, cephalometry, and computed tomography of the upper airway.All the cases were given continuousairway pressure via nose,five to seven days before operation and then were performed hyoid suspension plus coblation assisted uvulopalatopharyngoplasty(CAUP).The follow up period was at least 6 months postoperatively.The Wilcoxon Signed Rank test was used to compare the preoperative and postoperative results by SPSS11.0 for win-dows.Results:Postoperative 6-24 months, there were statistically significance in all but BMI between preoperativeand postoperative measurement. Mean RDI was reduced from preoperative(63.83±16.34)to postoperative(21.43±20.34),lowest mean oxygen saturation increased from (72.44±7.07)% to(81.33±13.32)%.According to the criterion of Huangzhou,the total effective rate was 83.33%. Conclusion: Hyoid suspension plus CAUP is on effective surgical approach for patients with severe OSAHS who suffer from oropharyngeal and hypopharyngeal obstruction.