悬雍垂腭咽成形术中咽侧壁的成形

目的:探讨悬雍垂腭咽成形术(UPPP)中咽侧壁的成形方法。方法:治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)23例,采用以下方法处理咽侧壁:①保留腭舌弓。②松解腭咽弓与软腭交界处,将软腭游离缘的两端向前移位。③腭咽弓缘固定于扁桃体窝外侧壁,使腭咽弓黏膜面构成口咽腔光滑的外侧壁。观察手术的近、远期效果。结果:患者术后局部反应较轻,腭咽形态保持较好,随访1～5年,疗效满意。结论:咽侧壁的处理与成形是UPPP中的一个重要环节,重视对其处理可提高UPPP的疗效。     

悬雍垂腭咽成形术加低温等离子射频消融的临床疗效分析

重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者,往往有多个阻塞平面同时存在,目前治疗有CPAP、UPPP及低温等离子射频治疗(RFA)等多种方法,以往我们对不能接受CPAP治疗的患者仅采用改良UPPP手术,虽获得了无食物鼻反流、开放性鼻音等并发症的效果,但术后远期疗效仍不理想。近几年,我科采用改良UPPP加RFA等综合治疗方法,明显提高了疗效,现报告如下。     

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。     

改良腭咽成形术合并多部位射频消融术手术疗效

目的 探讨改良腭咽成形术合并多部位低温等离子射频消融术治疗中、重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)手术疗效.方法 采用改良腭咽成形术合并多部位低温等离子射频消融术治疗中重度多平面阻塞OSAHS患者83例,全部随访2年以上,术后6、12、24个月复查多导睡眠图,判定疗效.结果 随访2年后,83例患者中,治愈24例(28.9%),显效28例(33.7%),有效17例(20.5%),无效14例(16.9%),总有效率83.1%;患者手术前后睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)变化有极显著统计学差异(P＜0.01);重度OSAHS患者手术前后最低血氧饱和度(SaO2)有显著变化(P＜0.05);全部病例均未出现严重并发症.结论 改良腭咽成形术合并多部位低温等离子射频消融术是治疗中重度OSAHS安全、有效的方法.     

局麻射频消融腭咽成形术与射频消融缩容术疗效比较

目的对局麻射频消融腭咽成形术与射频消融缩容术治疗阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS)的效果进行比较,为OSAHS的治疗提供客观依据。方法选用局麻射频消融腭咽成形术与射频消融缩容术分别对69例和79例OSAHS患者进行治疗,术后随访6个月和12个月,比较两种手术方法的疗效及并发症情况。结果术后6个月有效率分别为85.5%和81.0%,差异无显著性。术后12个月局麻射频消融腭咽成形术疗效优于射频消融缩容术,有效率分别为78.3%和49.3%,差异有显著性。两种手术方法均无严重并发症。结论局麻射频消融腭咽成形术较射频消融缩容术远期效果好,无严重手术并发症。在病例选择合适时用局麻方法可达到全麻手术效果。     

改良腭咽成形术

目的改良腭咽成形术结合射频技术形成针对不同病态上气道形态的个性化术式。方法34例患者经多导睡眠监测(polysomnography,PSG)确诊为中或重度阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS);根据气道形态将传统腭咽成形术(uvulopalatopharyngoplasty,UPPP)改良为侧重扩大横径和扩大矢径两种术式,并选择性地进行局部射频消融。全部患者以治疗前后的PSG、咽腔测量数据及主观感觉等指标作对照。结果随访30例患者,术后6个月复查睡眠呼吸暂停低通气指数(apneahypopneaindex,AHI)值由54.7±18.2降至26.4±8.6(P﹤0.01),总有效率86.7%。结论改良腭咽成形术结合射频技术以气道形态改变为基础选择手术适应证,可明显提高疗效。     

扁桃体大小对悬雍垂腭咽成形术疗效的影响

目的：研究扁桃体大小对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者UPPP疗效的影响。方法：回顾性分析我科行UPPP手术的OSAHS患者54例,术后1年以上复查PSG确定疗效。结果：不同扁桃体大小组术前的各项指标（年龄、AHI、BMI、最低SpO2）;总体均数间差异无统计学意义（P〉0．05）,但术后各扁桃体组间疗效差异有统计学意义;扁桃体Ⅲ度患者最低SpO2提高明显;在重度OSAHS中,不同疗效组间的扁桃体大小构成差异有统计学意义。结论：扁桃体较大患者手术有效率较高,其最低SpO2也有显著改善;对于重度OSAHS亦应根据个体差异采取不同的治疗措施。     

悬雍垂腭咽成形术治疗中度阻塞性睡眠呼吸暂停综合征的疗效观察

目的；探讨中度阻塞性睡眠呼吸暂停综合征（OSAS）的手术疗效。方法：采用改良悬雍垂腭咽成形术（UPPP），即扩大软腭切除范围，解剖腭帆间隙，保留悬雍垂及咽腔的基本结构治疗64例此种患者。结果：术后随访，6个月时复查多导睡眠监测仪，显效21例（32.8%)。有效24例（37.5%)。总有效率为70.3%。无效19例(29.7%)。结论：改良UPPP是治疗中度OSAS的有效方法。     

保留三角皱襞的悬雍垂腭咽成形术36例分析

UPPP是治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的主要外科治疗方法,该术式一般需要术中切除双侧扁桃体,腭舌弓和腭咽弓拉拢缝合以扩大咽腔和减小创面,但是,扁桃体窝下部封闭的创面常在术后短期内裂开,导致腭舌弓黏膜撕裂、术后出血概率增加和局部瘢痕面积过大等不良后果.为解决扁桃体窝下部创面裂开的问题,我们尝试在UPPP中保留三角皱襞,以扩大黏膜覆盖面积和减低缝合时的张力,现报告如下.     

扁桃体大小对悬雍垂腭咽成形术疗效评估的意义

目的：探讨扁桃体大小对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者行悬雍垂腭咽成形术（UPPP）疗效评估的意义。方法：分析主要存在腭咽平面狭窄而行UPPP手术的60例OSAHS患者术后1年以上疗效、Epworth 嗜睡评分(ESS）、PSG主要指标的变化。结果：不同扁桃体大小组术前的各项指标(年龄、AHI、BMI、最低SaO2)总体均数间差异无统计学意义(P＞0.05),但术后各扁桃体组间疗效差异有统计学意义(χ2＝4.28,P=0.039);扁桃体Ⅰ度肿大组（A组28例）临床症状明显改善（包括显效和有效）17例,扁桃体Ⅱ、Ⅲ度肿大组（B组32例）临床症状明显改善27例。Epworth嗜睡评分：A组由术前的13.7±4.6下降为8.5±3.8(t=4.61,P=0.000?0),B组由术前的14.2±4.5下降为7.5±3.3(t=6.79,P=0.000?0);但两组之间比较无明显差异（t=1.091?2,P=0.279?7）;多导睡眠监测（PSG）指标B组AHI下降更明显,两组比较有统计学差异（t=2.37,P=0.021）。两组最低SaO2及微觉醒指数提高明显,但两组之间比较无统计学差异。结论：扁桃体较大的OSAHS患者行UPPP手术有较好的治疗效果,其AHI也有更显著的改善。     

等离子辅助悬雍垂腭咽成形术联合舌打孔术治疗重度OSAHS

目的:探讨应用等离子辅助下的悬雍垂腭咽成形术(CAUPPP)联合舌打孔术(CCT)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:回顾性分析我科经手术治疗的重度OSAHS患者296例。术前经PSG监测:AHI≥40,LSaO2≤80%。患者均行CAUPPP联合CCT术,行CAUPPP以减容软腭,行CCT以减容舌。术后分别于6个月、12个月随访行PSG监测。结果:患者主观症状较术前明显改善,软腭功能良好,无明显鼻咽反流出现。术后与术前比较AHI值下降(P<0.01),且LSaO2升高(P<0.01)。术后有效率为91.7%。结论:重度OSAHS患者常存在多平面狭窄,CAUPPP联合CCT是一种治疗重度OSAHS的有效手术方法,具有出血少、创伤小和保留正常软腭功能等优点,值得临床推广应用。     

CO2激光辅助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的疗效评价

目的：探讨CO2激光辅助悬雍垂腭咽成形术（LAUP）治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的疗效。方法：96例确诊为OSAHS接受CO2 LAUP治疗的患者，对术前和术后6个月PSG资料进行分析。结果：术后6个月随访治愈29例，显效34例，有效13例，无效20例；有效率达到79．17％（76／96）。结论：应用CO2 LAUP治疗OSAHS是一种安全有效的方法。     

Complications of uvulopalatopharyngoplasty

Since the introduction of uvulopalatopharyngoplasty (UVPP) life-threatening complications have been encountered. In our retrospective review of 101 patients undergoing UVPP the overall incidence of early post-operative complications was 25%. One patient died because of post-operative airway obstruction. The risk of early post-operative breathing difficulty was related to the patient's weight, previous heart disease, and severity of OSAS measured by the percentage of obstructive apnoeic episodes and minimum oxygen saturation during sleep. As late as one year after surgery 57% of patients had some kind of problem in relation to the operation, the most common complaint being nasopharyngeal regurgitation (24%). Despite these late complications over 90% of the patients reported improvement in daytime somnolence and snoring.     

轻中度阻塞性睡眠呼吸暂停低通气综合征疗效比较

目的比较悬雍垂腭咽成形术（uvulopalatopharyngoplasty,UPPP）和等离子低温射频消融（radiofrequency ablation,RFA）治疗轻中度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）的疗效.方法选择79例轻中度OSAHS患者（阻塞平面位于腭和扁桃体水平）,随机分成两组分别接受UPPP和RFA治疗,比较术前和术后呼吸暂停低通气指数（apnea hypopnea index,AHI）、最低血氧饱和度（lowest saturation of blood oxygen,LSaO2）、鼾声评级及Epworth嗜睡程度评分,比较术后3天时和7天时疼痛、讲话及吞咽的影响评分,并比较两组患者之间的差异.结果UPPP组和RFA组有效率分别为74.3%和72.2%,疗效相近.两组患者术前和术后6个月多导睡眠描记（polysomnography,PSG）监测比较显示：治疗后LSaO2显著提高（P＜0.05）,AHI的减低非常显著（P＜0.01）,两组患者之间比较无明显差异;两组患者治疗8周后鼾声评级较治疗前降低非常显著（P＜0.01）,Epworth嗜睡程度评分亦较治疗前降低非常显著（P＜0.01）,两组患者之间比较无明显差异;术后3天时比较,RFA组比UPPP组疼痛和吞咽明显轻微（P＜0.05）,两组患者讲话无明显差异;术后7天时比较,RFA组比UPPP组疼痛明显轻微（P＜0.05）,两组患者讲话和吞咽无明显差异.结论RFA治疗轻中度OSAHS安全、创伤小、恢复快,疗效与UPPP相近.     

低温等离子射频治疗儿童阻塞性睡眠呼吸暂停低通气综合征768例研究

目的：总结分析儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）低温等离子射频治疗的手术方法及临床疗效。方法：回顾性研究经低温等离子射频治疗的768例OSAHS患儿,单纯扁桃体切除39例,单纯腺样体切除192例,扁桃体全部切除＋腺样体切除243例,扁桃体部分切除＋腺样体切除294例,总结分析其临床疗效、术后并发症及术前术后睡眠监测结果。结果：创面假膜脱落时间为术后10~14d,11例患儿术后1周出现扁桃体窝继发出血,21例患儿术后半年舌根及咽后壁淋巴组织代偿性增生,术后睡眠打鼾、憋气及张口呼吸症状均有不同程度改善,经不同术式治疗的OSAHS患儿术后3个月的睡眠监测结果较术前均有明显改善,差异具有统计学意义（P〈0.01）。结论：低温等离子射频是治疗儿童OSAHS行之有效的方法,对于腺样体和扁桃体的处理,可根据患儿不同情况选择不同术式,对于合并分泌性中耳炎鼓室积液的患儿,可行鼓膜穿刺术。     

Increase of the apnoea–hypopnoea index after uvulopalatopharyngoplasty: analysis of failure1

From 70 patients who had uvulopalatopharyngoplasty (UPPP) operation and a pre‐ and postoperative sleep registration, we could retrospectively determine the failures and the correlation between variables such as age, gender, body mass index (BMI), earlier or concomitant tonsillectomy, unilevel (uvula–palate–tonsil) or multilevel (base of tongue as well) obstruction during sleep endoscopy and treatment outcome. From 70 patients, the preoperative sleep registration classified 15 social unacceptable snorers and 55 obstructive sleep apnoea syndrome (OSAS) patients. In this study we focused on the OSAS patients. From the 55 OSAS patients, 32 were classified as successful after UPPP, because they had a decreased apnoea–hypopnoea index (AHI) after surgery (≤20). Eight patients had a decreased AHI, but more than 20 apnoeas/hypnoeas per hour. Fifteen patients were identified as UPPP failures with an equal or increased AHI and/or subjective deterioration of snoring. We were unable to find a statistically difference between the two groups with respect to variables such as age, BMI and AHI preoperative (P > 0.56) as between the level of obstruction(s) (P > 0.24). For earlier or concomitant tonsillectomy we found a statistically difference (P > 0.039), but a very small number in the high failure group (n = 8). We conclude that although sleep endoscopy adds to better patient selection and better results, paradoxically, the finding of obstruction on palate–uvula level during sleep endoscopy can still give UPPP failures.     

软腭、舌体低温等离子消融配合H-UPPP治疗重度OSAHS 30例分析

目的 探讨应用改良的悬雍垂腭咽成形术（H-UPPP）配合软腭、舌体低温等离子消融治疗腭-咽平面、舌-咽平面阻塞所致的重度阻塞性睡眠呼吸暂停低通气综合征的可行性、优越性和注意事项。方法 对30例经多导睡眠监测，Muller动作检测确定的因腭-咽平面、舌-咽平面阻塞所致的重度阻塞性睡眠呼吸暂停低通气综合征患者进行了改良的悬雍垂腭咽成形术（H-UPPP）配合软腭、舌体低温等离子消融，术中完整保留悬雍垂,切除腭帆间隙脂肪组织,扩大软腭成形范围，并于软腭及舌体低温等离子打孔消融，全部患者均分别进行了术前和术后6个月、1年、3年多导睡眠监测。结果 按照杭州会议疗效评定标准，6月内有效率100.00%，1年有效率83.33%，3年有效率76.67%，无1例术中或术后行气管切开术，无1例出现软腭粘连、鼻咽狭窄、大出血、开放性鼻音、死亡。结论 对腭-咽平面、舌-咽平面阻塞所致的重度阻塞性睡眠呼吸暂停低通气综合征的患者，软腭、舌体低温等离子消融配合H-UPPP治疗是安全、有效的，具有简单、微创，无需气管切开，愈合快等优点，同时应注意术前应用CPAP治疗，全麻清醒后24h才拔出气管插管。     

Predictive factors of immediate postoperative complications after uvulopalatopharyngoplasty

OBJECTIVES/HYPOTHESIS: This study was performed to assess the relationships between polysomnographic data, including the level of obstruction inducing apnea, and immediate postoperative complications or oxygen saturation in patients who had undergone uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: Retrospective study. METHODS: Using the data of 90 patients with a polysomnography-confirmed diagnosis of OSAS who had undergone UPPP surgery with/without tonsillectomy under general anesthesia, we determined apnea-hypopnea indices (AHI), preoperative lowest arterial saturation (LSAT-PREOP) levels, percentages of obstruction at the upper level of the uvula during apnea (AL-U), need for an airway in the postanesthesia care unit (PACU) or during the first postoperative night in a ward (POPN1), LSAT- PACU, LSAT-POPN1, and the incidence of postoperative bleeding or other complications. RESULTS: Postoperative complications developed in 19 (21.1%) of the 90 patients, airway-related complications in 5 (5.6%), oxygen desaturation in 8 (8.9%), excessive or recurrent bleeding in 7 (7.8%), and a postoperative electrocardiogram change in 1(1.1%). Patients with postoperative complications had higher AHI (68.1 vs. 49.3, P = .008), lower LSAT-PREOP (71.1 vs. 77.8, P = .012), and lower AL-U (24.2 vs. 57.4, P = .005) than those without. After UPPP surgery, LSAT-POPN1 improved more than LSAT-PREOP (94.4 vs. 76.2%, P = .03), and LSAT-POPN1 correlated with LSAT-PREOP (r = 0.274, P = .014) and AL-U (r = 0.286, P = .046). CONCLUSIONS: This study shows that immediate postoperative complications and oxygen saturation are associated with OSAS severity and the level of obstruction, inducing apnea in those who have undergone UPPP for OSAS.     

同期悬雍垂腭咽成形术联合颏前移术治疗OSAHS近期疗效观察

目的：探讨同期悬雍垂腭咽成形术（UPPP）加颏前移术治疗OSAHS的近期疗效。方法：将40例OSAHS患者分A、B组,A组行UPPP加颏前移术,B组行UPPP。术后6个月行多导睡眠监测,比较术前、术后的变化。结果：A组有效率为100％,B组有效率为85％。A、B组术后AHI、LSaO2及嗜睡评分与术前比较均差异有统计学意义（均P〈0．05）。结论：同期UPPP加颏前移术治疗OSAHS效果可靠,值得推广。