传统及改良悬雍垂腭咽成形术对持续正压通气治疗的影响

目的　探讨传统悬雍垂腭咽成形术 (uvulopalatopharyngoplasty ,UPPP)及改良悬雍垂腭咽成形术后对阻塞性睡眠呼吸暂停低通气综合征 (obstructivesleepapnea hypopneasyndrome ,OSAHS)患者持续正压通气 (continuouspositiveairwaypressure,CPAP)治疗的影响。方法　选择传统UPPP及改良UPPP的OSAHS患者分别为 2 4例和 42例 ,术后随访 1 2个月以上 ,比较两种术式的疗效 ,并对其中的2 4例传统UPPP和 1 5例改良UPPP术后患者进行睡眠状态下CPAP治疗压力耐受性测试。结果　术后 1年两种术式治疗OSAHS的有效率分别为 58 3 %和 61 9% ,差异无显著性。 2 4例传统UPPP患者术后有 4例 (1 6 7% )患者在CPAP治疗时产生严重的口腔漏气 ,不能耐受CPAP治疗 ;1 5例改良UPPP术后患者的CPAP压力耐受性与未行手术者相似。结论　OSAHS患者手术时应尽量保留悬雍垂 ,保留咽腔基本解剖结构 ,为下一步的CPAP治疗提供良好的基础     

阻塞性睡眠呼吸暂停低通气综合征行腭咽成形术围手术期的临床研究

目的探讨腭咽成形术(uvulopalatopharyngoplasty,UPPP)治疗中、重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)围手术期的临床处理.方法对54例中、重度OSAHS患者实施了腭咽成形术,围手术期的处理包括(1)多道睡眠监测和心肺功能评估;(2)术前44例、术后29例行正压通气治疗;(3)静脉诱导吸入全身麻醉46例,局部浸润麻醉8例;(4)42例行保留悬雍垂的改良腭咽成形术.结果术前未接受CPAP治疗的局麻患者术中出现短暂呼吸困难2例,术后高血压危象、心动过速各1例,术后原发性出血2例.CPAP治疗组在麻醉清醒期及术后无急性上气道阻塞发生.全身麻醉5例插管困难,有高血压病史的19例术中血液动力学波动大.经典腭咽成形术后1周内腭咽关闭不全4例,行保留悬雍垂的改良腭咽成形术后咽部有异物感9例,但无其他并发症.结论充分认识UPPP 手术存在的潜在风险,认真进行围手术期的正确治疗有助于减少手术并发症,提高手术和麻醉的安全性.     

两种改良UPPP对重度OSAHS患者的疗效观察

目的比较不保留悬雍垂改良悬雍垂腭咽成形术(UPPP)和保留全部或部分悬雍垂改良UPPP对无下咽阻塞的重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者短期和长期的疗效.方法选择重度OSAHS患者27例,采用改良UPPP为主的综合治疗,全部病例术后随访6个月及2年,比较其疗效.结果不保留悬雍垂改良UPPP组15例,保留全部或部分悬雍垂改良UPPP组12例,术后6个月,后者总有效率为66.7%,前者总有效率为86.7%,但差异无显著性(P>0.05).术后2年,不保留悬雍垂改良UPPP组总有效率为73.3%,明显高于保留全部或部分悬雍垂改良UPPP组总有效率的33.3%,两组总有效率差异有显著性(P<0.05).结论根据不同的阻塞部位采用不同的改良UPPP术式是取得满意疗效的关键.     

低温等离子射频治疗睡眠呼吸暂停低通气综合征46例

阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apneahypopnea syndrome,OSAHS)随着肥胖人群增多，其发病率有上升趋势。传统的悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)及各种改良手术，患者均感术中(局麻手术者)及术后痛苦大，许多患者不愿接受。我院自2000年10月～2002年3月采用等离子低温射频治疗机(美国产coblator．ENTEC，简称射频)手术治疗OSAHS患者46例，取得了明显疗效，现报告如下。     

射频等离子悬雍垂腭咽成形术疗效观察

目的:探讨腭咽射频等离子成形术治疗腭咽平面阻塞所致的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法:将81例以腭咽平面阻塞所致的OSAHS患者分成两组,分别进行UPPP和腭咽射频等离子成形术。结果:术后6个月随访,两组疗效相当。结论:悬雍垂腭咽射频等离子成形术时间短、出血少、安全、术后疗效满意。     

改良UPPP治疗阻塞性睡眠呼吸暂停低通气综合征

目的观察改良悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征（Obstructive sleep apnea hypopnea syndrome,OSAHS）的疗效。方法回顾性分析2004-2008年本科收治的48例OSAHS患者临床资料及其临床疗效。所有患者均在经鼻腔插管全身麻醉下行改良悬雍垂腭咽成形术,术后随访1-2年。结果本组病例中,治愈13例（27．08％）,显效22例（45．83％）,有效9例（18．75％）,无效4例（8．33％）,总有效率91．7％。结论全麻下改良悬雍垂腭咽成形术治疗阻塞部位位于口咽部的OSAHS患者安全可靠,疗效肯定。     

改良悬雍垂腭咽成形术长期疗效的主观评价

目的 评价保留悬雍垂的改良悬雍垂腭咽成形术(Han-uvulopalatopharyngoplasty,H-UPPP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者术后5年的主观疗效改善程度.方法 回顾性队列研究.电话问卷随访2165例确诊5年及以上的OSAHS患者(呼吸暂停低通气指数≥5次/h),分为未治疗组、...     

保留悬雍垂的腭咽微波成形术的临床疗效观察

目的：探讨腭咽微波成形术治疗腭咽平面阻塞所致的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的治疗效果。方法：对61例腭咽平面阻塞所致的OSAHS患者进行腭咽微波成形术,其中9例单纯行腭咽微波成形术,36例加双侧腭扁桃体切除术。16例加双侧腭扁桃体切除术及舌根微波消融术。结果：悬雍垂术后约2周开始回缩,约3个月接近或达到正常水平,保留咽腔的基本形态结构。无一例出现腭咽关闭不全。21例术后有咽部异物感,持续2～5个月渐消失。6个月后随访,治愈13例(21．31％),显效32例(52．46％),有效12例(19．67％),无效4例(6．56％),总有效率93．44％。结论：悬雍垂腭咽微波成形术手术时间短、出血少．术后效果满意。     

单极电刀辅助行改良悬雍垂腭咽成形术23例

改良悬雍垂腭咽成形术(uvulopalatopharyngoplasty, UPPP)是治疗以口咽部阻塞为主要病变部位的阻塞性睡眠呼吸暂停低通气综合症(obstructive sleep apnea hypopnea syndrome, OSAHS)的主要方法,疗效确切,我科采用单极电刀辅助行改良UPPP治疗OSAHS患者23例,取得较好疗效,报道如下.     

改良保留悬雍垂腭咽成形术治疗阻塞性睡眠 呼吸暂停低通气综合征疗效分析

目的探讨改良保留悬雍垂腭咽成形术治疗因软腭肥厚导致阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的手术方法及疗效。方法2013年4月~2014年4月对65例软腭肥厚腭咽平面狭窄的中重度OSAHS患者行软腭正中切开联合改良保留悬雍垂腭咽成形术,术前及术后行上气道CT等相关检查,分析65例患者手术后的疗效及各参数的变化情况。结果65例患者手术后1年呼吸暂停低通气指数(AHI)由(42.58±5.66)次/h降低至(15.26±3.39)次/h,差异具有统计学意义(P<0.01);最低血氧饱和度由0.743±0.063提高至0.8613±0.053,差异具有统计学意义(P<0.01);Epworth嗜睡量表4个指标均较术前有明显改善(P<0.01)。65例患者中治愈31例(47.7％),显效30例(46.2％),有效3例(4.6％),无效1例(1.5％)。3例患者术后3个月有轻微吞咽障碍及咽痛,2例患者术后7 d出现扁桃体窝出血,局部压迫后止血。结论改良保留悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征术式相对简单,主观疗效较好,且并发症较少,临床可选择性采用。     

悬雍垂腭咽成形术后持续正压通气治疗

观察悬雍垂腭咽成形术（ｕｖｕｌｏｐｌａｔｏｐｈａｒｙｇｏｐｌａｓｔｙ,ＵＰＰＰ）后疗效不佳的阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ,ＯＳＡＳ）患者为手术组行持续正压通气（ｃｏｎｔｎｕｏｕｓｐｏｓｉｔｉｖｅａｉｒｗａｙｐｒｅｓｓｕｒｅ,ＣＰＡＰ）治疗的效果。方法１５例ＵＰＰＰ术后呼吸暂停低通气指数（ａｐｎｏｅａ－ｈｙｐｏｎｏｅａｉｎｄｅｘ,ＡＨＩ）仍大于     

中重度阻塞性睡眠呼吸暂停低通气综合征患者低氧血症与肿瘤坏死因子-α相关研究

目的探讨中重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者序贯治疗前后,夜间低氧血症与血清肿瘤坏死因子-α（tumornecrosisfactoralpha,TNF—α）水平的相关性。方法对44例中重度OSAHS患者检测低氧血症指标及血清TNF-α浓度后予以手术治疗。其中,27例患者先后行鼻平面手术和口咽平面UPPP,11例行UPPP,6例鼻平面手术。术后6个月复查血清TNF-α浓度及低氧血症指标,仍异常者采用持续气道正压通气（CPAP）治疗6个月后复查。另选择38例年龄、性别和体重指数（BMI）等均相匹配者作为对照。结果①OSAHS患者清晨与睡前血清TNF—α浓度变化值与低氧血症各指标密切相关;②OSAHS组患者术后6个月低氧血症指标仍异常者,TNF-α浓度变化值与低氧血症各指标相关性密切;③术后6个月低氧血症指标仍异常者,CPAP治疗6个月前后,低氧血症指标与TNF—α浓度变化值已无相关性。结论OSAHS患者清晨与睡前、手术治疗前后,血清TNF-α与低氧血症参数间存在相关性。术后联合CPAP的序贯治疗可进一步降低TNF-α浓度和低氧血症参数。     

舌骨悬吊联合悬雍垂腭咽成型术治疗重症阻塞性睡眠呼吸暂停低通气综合征

目的：探讨舌骨悬吊联合腭咽成型手术治疗重症睡眠呼吸暂停低通气综合征的手术方法和效果。方法：对22例符合重症阻塞性睡眠呼吸暂停低通气综合征标准的患者进行了改良的舌骨悬吊联合腭咽成型手术，并对所有的患者进行了随访，对17例患者进行了手术前后的舌咽平面间隙的测量和睡眠呼吸监测。结果：随访结果显示，17例术后6、12个月两项睡眠监测指标均较术前有明显改变（P＜0.01），舌-咽距离由术前5.00～9.00?mm（平均为7.06?mm），增加到术后的9.00～13.00?mm（平均为11.00?mm）。打鼾症状明显减轻或消失，呼吸暂停次数明显减少，白天嗜睡消失或基本消失，精力充沛。根据杭州疗效评定标准，术后6个月及1年的有效率均为100%，但治愈率和显效率有所变化。结论：改良的舌骨悬吊联合腭咽成型手术简单，时间短，花费少，效果好，值得临床推广。     

低温等离子辅助改良腭咽成形联合舌减容和鼻腔扩容术对中重度OSAHS的近期疗效和安全性评价

目的 探讨低温等离子辅助改良悬雍垂腭咽成形术(UPPP)、舌减容联合选择性鼻腔扩容术治疗中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的近期疗效、安全性及临床应用价值等。 方法 回顾分析淮安市第二人民医院耳鼻咽喉科2013年10月~2016年5月收治的164例中重度OSAHS患者,按手术方式不同分为观察组和对照组,每组82例患者。观察组在充分围手术期准备的基础上,采取低温等离子辅助改良UPPP、舌体舌根减容以及选择性鼻腔扩容术,对照组常规UPPP加鼻腔扩容术进行治疗。比较两组临床疗效、手术并发症情况等指标。 结果 术后随访6个月,观察组和对照组的总有效率分别为81.7%和62.2%,差异有统计学意义(P<0.05)。随访1年,观察组和对照组的总有效率分别为75.6%和51.2%,差异也有统计学意义(P<0.05)。观察组手术并发症发生率明显低于对照组(P<0.05)。 结论 对有手术适应证的中重度OSAHS行低温等离子辅助改良UPPP联合舌减容和选择性鼻腔扩容术,可取得较为满意的治疗效果,安全性良好,但术后1年以上的远期疗效有待进一步随访观察。     

个体化鼻腔扩容术对阻塞性睡眠呼吸暂停低通气综合征治疗效果的研究分析

目的 针对有鼻塞症状的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者,施行个体化的鼻腔扩容术,研究鼻腔扩容术治疗OSAHS的临床效果.方法 选取2018年1月至2019年6月于山东大学齐鲁医院(青岛)行个体化鼻腔扩容术治疗伴有鼻塞症状的成年OSAHS患者42例;术前及术后3个月分别行多导睡眠监测(PSG)、鼻声反射、...     

A Prospective Study of the Surgical Outcome of Simple Uvulopalatopharyngoplasty (UPPP), UPPP Combined With Genioglossus Advancement or Tongue Base Advancement for Obstructive Sleep Apnea Hypopnea Syndrome Patients With Multilevel Obstruction

ObjectivesTo investigate the surgical outcomes of different uvulopalatopharyngoplasty (UPPP).Methods All subjects underwent overnight polysomnography and were evaluated using the Epworth sleepiness scale (ESS), the Quebec sleep questionnaire and the snoring scale at the baseline and 3 and 12 months following operation. The primary endpoint was the overall effective rate representing the sum of the surgical success rate and effective rate.ResultsThe overall effective rate at 12 months post surgery was 55.6% for simple UPPP, 95.8% for UPPP+GA, and 92.3% for UPPP+TBA. The surgical success rate at 3 and 12 months postoperation for UPPP+GA or UPPP+TBA was significantly higher than simple UPPP (P<0.05). Marked improvement was observed in all patients in the snoring scale score and the ESS score 3 and 12 months following surgery compared to the baseline (P<0.05 in all).ConclusionUPPP, UPPP+GA, and UPPP+TBA are all effective in improving the surgical outcome of obstructive sleep apnea hypopnea syndrome (OSAHS) patients with multilevel obstruction. UPPP+TBA appears to be the most effective in treating OSAHS patients.     

Associated predictors of therapeutic response to uvulopharyngopalatoplasty for severe obstructive sleep apnea hypopnea syndrome

The aim of this study was to determine the associated factors affecting the outcome of uvulopharyngopalatoplasty (UPPP) in patients with severe obstructive sleep apnea hypopnea syndrome (OSAHS), and to investigate whether cephalometric measurements were predictive of the therapeutic response to UPPP in patients with severe OSAHS. We retrospectively studied 51 consecutive patients who underwent revised UPPP with uvula preservation (H-UPPP), or Z-palatopharyngoplasty (ZPPP) for severe OSAHS [apnea–hypopnea index (AHI) >30]. All patients were evaluated using physical examination, Epworth Sleepiness Scale (ESS), cephalometry, and nocturnal polysomnography (PSG) before surgery and at 6–12 months after surgery. Based on the success criteria defined as an AHI of <20 and a decrease >50 %, the overall success rate was 45.1 %. The preoperative distance from the posterior border of the uvula to the middle pharyngeal wall (U-MPW) was significantly longer in the responder group than in the nonresponder group, when considering the whole group or the H-UPPP group alone. Among all study subjects, U-MPW and change in body mass index (△BMI) were the significant predictors of surgical success. U-MPW was the key predictor for H-UPPP surgical success, whereas mandibular plane angle (MPA) and Friedman stage were the key predictors for ZPPP surgical success. In conclusion, U-MPW was a significant predictor of UPPP surgical success. Patients with U-MPW >10 mm who are unwilling to receive nasal continuous positive airway pressure (CPAP) therapy might be suitable candidates for UPPP surgery.     

同期鼻腔手术+悬雍垂腭咽成型术治疗阻塞性睡眠呼吸暂停低通气综合征

目的 探讨同期鼻腔手术+悬雍垂腭咽成型术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效情况。方法 对40例伴有鼻阻塞的OSAHS患者分A、B两组,Ａ组行鼻腔手术+悬雍垂腭咽成型术(UPPP),Ｂ组行悬雍垂腭咽成型术,术后6个月复查睡眠监测,比较术前术后呼吸暂停低通气指数(AHI)。结果 Ａ、Ｂ两组OSAHS患者术后AHI平均值均降低,Ａ组有效率较Ｂ组高。结论 同期鼻腔手术+悬雍垂腭咽成型术治疗鼻腔、咽腔双平面阻塞的OSAHS患者效果可靠,值得推广。     

Reoperation on patients with obstructive sleep apnea–hypopnea syndrome after failed uvulopalatopharyngoplasty

The goals of this study were to explore the reasons after failed uvulopalatopharyngoplasty (UPPP) in some patients with obstructive sleep apnea–hypopnea syndrome (OSAHS), and to observe the efficacy of the second surgery. Twenty-three OSAHS patients with failed UPPP were included in the study. Routine physical exams, electronic endoscopy, computed tomography scan and polysomnography after nasopharyngeal tube insertion were performed to assess the site of upper airway obstruction, and corresponding appropriate surgical treatment was carried out based on the diagnosis. Comprehensive evaluation of the 23 patients revealed that the sites of obstruction after failed UPPP were as follows: 7 cases predominantly in the oropharyngeal area, 2 cases in the nasal, nasopharyngeal and oropharyngeal area, 5 cases predominantly in the glossopharyngeal area and 9 cases in the oropharyngeal and glossopharyngeal areas. Correspondingly, 7 cases underwent improved UPPP alone, 2 cases underwent adenoidectomy or nasal expansion and improved UPPP, 5 cases underwent glossopharyngeal surgery alone and 9 cases underwent improved UPPP and glossopharyngeal surgery. Follow-up for more than 12 months showed that there were four cured cases, 12 cases with marked improvement, and 7 cases with treatment failure. The success rate was 69.6 %. After undergoing UPPP, OSAHS patients may still have oropharyngeal airway obstruction. By performing a detailed preoperative assessment on the patient’s airway condition and clarifying the site of obstruction, performing the second surgical treatment can still achieve a relatively satisfactory treatment outcome.