腭咽成形术中保留悬雍垂的意义

目的　改进经典悬雍垂腭咽成形术 (uvulopalatopharyngoplasty ,UPPP)手术方法 ,探讨术中保留悬雍垂的意义 ,提高UPPP手术疗效、减少术后并发症。方法　治疗睡眠呼吸暂停综合征患者 30例。①在主观症状改善的基础上 ,应用多导睡眠图分析及咽腔解剖参数测量等项指标 ,术后随访 6个月以上 ,对术前术后所获资料进行统计学分析。②手术改进特点 :力求维持咽腔正常生理解剖形态 ,完整保留悬雍垂 ,解剖切除腭帆间隙脂肪组织 ,扩大软腭成形范围 ,平均软腭切除最高点在悬雍垂根部两侧上 1 9cm。结果　主观症状明显改善者占 87 0 % ,以AHI下降 >5 0 %为判定标准 ,有效率为5 3 3 % ,对轻、中度患者 (AHI<5 0 )有效率达 73 3 % ,无 1例出现腭咽关闭不全、咽腔瘢痕狭窄、误咽等并发症。术后咽腔解剖测量 :完整保留的悬雍垂术后 2周左右开始回缩 ,3～ 6个月接近并达到正常水平。结论　此术式可有效扩大咽腔 ,避免腭咽关闭不全等并发症 ,提高UPPP手术疗效 ;完整保留的悬雍垂依靠术后悬雍垂肌、腭帆提肌、腭帆张肌的运动及两侧软腭愈合引起的向上向外的牵拉作用 ,可以逐步回缩至正常生理水平     

悬雍垂—软腭折叠成形术治疗阻塞性睡眠呼吸暂停低通气综合征

OBJECTIVE: To explore the effect of the modified (Uvulopalatopharyngoplasty, UPPP) where uvula is reserved completely and the soft palate is folded in the operation. METHODS: 36 patients with the obstructive sleep apnea-hypopnea syndrome (OSAHS) (30 men, 6 women) underwent operation. The uvula and the muscles of the soft palate were reserved completely, and the soft palate was folded during the operation. RESULTS: 31 patients (86.1%) reported improvement of snoring and daytime somnolence. 30 patients (83.33%) showed a decrease of at least 50% in the apnea and hypopnea indices (AHI). No velopalatal insufficiency occurred. CONCLUSION: The modified UPPP not only enlarges pharyngeal cavity, but also avoids the postoperative complications. The modified UPPP could be better than the traditional operation.     

悬雍垂-软腭折叠成形术治疗阻塞性睡眠呼吸暂停低通气综合征

目的　改进经典悬雍垂腭咽成型术 (uvulopalatopharyngoplasty ,UPPP)的手术方法 ,提高治疗阻塞性睡眠呼吸暂停低通气综合征 (obstructivesleepapnea hypopneasyndrome ,OSAHS)的治疗效果 ,减少术后并发症。方法　用新改进的术式治疗OSAHS患者 3 6例 ,轻度 8例 ,中度 2 1例 ,重度 7例。在常规UPPP手术基础上完整保留悬雍垂及腭肌 ,切除软腭口咽面下段 1/ 3～ 1/ 2的黏膜及黏膜下部分脂肪组织 ,再将软腭自游离缘向上折叠并与上切缘缝合 ,形成新软腭。保留软腭的活动与功能。结果　 3 1例 ( 86 1% )诉睡眠时鼾声、白天嗜睡和晨起头痛等症状明显改善。术后 6个月复查 ,3 0例( 83 3 3 % )低通气指数下降超过 5 0 % ,19例 <5次 /h ,9例≤ 2 0次 /h ,6例≤ 40次 /h。没有出现术后出血、开放性鼻音、长期饮食返流、鼻咽腔瘢痕性狭窄等并发症。结论　此改进术式在有效扩大咽腔 ,尤其是软腭后间隙的基础上 ,避免了腭咽关闭不全、饮食返流、鼻咽腔瘢痕性狭窄等并发症 ,疗效良好     

保留悬雍垂的腭咽成形术临床应用初探

目的 改进经典悬雍垂腭咽成形术手术方法，探讨保留悬雍垂的可行性和必要性。方法 经多导睡眠监测确诊为阻塞性睡眠呼吸暂停低通气综合征60例，全身麻醉下行保留悬雍垂的腭咽成形术，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。结果 主观症状明显改善，术后8d，睡眠状态下心电监护仪血氧饱和度监测，平卧≥87%，侧卧≥90%。完整保留的悬雍垂术后2周开始回缩，2-3个月接近或达到正常水平，保留了咽腔基本形态结构，有效防止腭咽关闭不全的发生。6个月后随访采用多导睡眠监测，以睡眠呼吸暂停低通气指数下降50T为判断标准，有效率达83%（50/60）。结论 腭咽成形术中保留悬雍垂是可行和必要的。     

改良悬雍垂腭咽成形术疗效的临床观察

目的:改进经典悬雍垂腭咽成形术(UPPP) 的手术方法，探讨保留悬雍垂的可行性和必要性。方法：全身麻醉下行保留悬雍垂的腭咽成形术，术中完整保留悬雍垂，切除腭帆间隙脂肪，提高软腭最高切点均在2.5?cm 以上。结果：完整保留的悬雍垂术后2周开始回缩，3个月后咽腔接近年轻状态，无腭咽关闭不全及再狭窄。主观问卷调查和PSG客观检测有效率为100%。结论：保留悬雍垂可提高软腭最高切点开大咽腔，扩大软腭鼻咽面和咽后壁间距并防止腭咽关闭不全，可明显提高UPPP手术疗效。     

阻塞性睡眠呼吸暂停低通气综合征患者手术前后口咽腔测量分析

目的　探讨阻塞性睡眠呼吸暂停低通气综合征 (obstructivesleepapnea hypopneasyndrome ,OSAHS)患者口咽腔扩大的程度与疗效的关系。方法　对 38例OSAHS行悬雍垂腭咽成形术 (uvulopalatopharyngoplasty ,UPPP)的病例进行手术前后口咽腔测量 :悬雍垂基底宽、悬雍垂长、悬雍垂至咽后壁间距、腭舌弓间距和腭咽弓间距。并观察呼吸暂停低通气指数 (apnea hypopneaindex ,AHI)、体块指数 (bodymassindex ,BMI)、血氧饱和度 (oxygensaturation ,SaO2 )的变化。结果　OSAHS患者手术前的腭舌弓间距和腭咽弓间距比对照组窄 (P <0 0 5 ) ,而至咽后壁的距离 ,悬雍垂长、宽两组数据间差异无显著性 (P >0 0 5 )。手术后腭舌弓间距、腭咽弓间距、至咽后壁的距离与对照组比较差异无显著性 (P >0 0 5 )。有效组和无效组比较 ,手术前呼吸暂停低通气指数、体块指数、最低SaO2 、平均SaO2 、悬雍垂至咽后壁间距、腭舌弓间距和腭咽弓间距、悬雍垂长、宽在统计学上差异无显著性(P >0 1)。结论　OSAHS患者的口咽部左右径小于健康人 ,而前后径与健康人相近。UPPP手术可以显著扩大咽腔口咽部左右径 ,达到健康人水平。UPPP手术疗效不仅仅与解剖结构异常有关 ,还存在其他影响因素     

Uvulopalatopharyngoplasty without complications: a Fujita complication

In 17 illustrations, a modification of Fujita's technique of UPPP is presented. This operation consists of excising redundant velar tissues from the free margin of the soft palate, tonsillar pillars, and uvula without reducing the muscles of the velum. In addition, the uvula muscle is almost completely preserved. Seventy patients, with habitual snoring or with obstructive sleep apnea syndrome, who underwent this surgery were followed-up from six to 24 months and did not show any palatal insufficiency with air and liquid escape through the nose. Additional remarks are made concerning the difficulties encountered during intubation of 60 percent of patients with chronic rhonchopathy.     

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.     

Revised uvulopalatopharyngoplasty with uvula preservation and its clinical study

OBJECTIVES: A revised uvulopalatopharyngoplasty (UPPP) is reported for reducing the surgical complications without compromising the response. METHODS AND MATERIALS: A new method of performing UPPP was designed, in which the uvula is preserved, but a larger portion of the soft palate is removed. This new procedure is called the 'revised UPPP with uvula preservation' (Han's UPPP or H-UPPP), the characteristics of which are as follows: complete preservation of the uvula; larger portion of the soft palate resected (with the levator palati and tensor palati remaining intact); the adipose tissue in the space of the velum palati is removed; the preserved uvula will become a 'normal' one by the contraction of scar tissue on both sides of the musculus palato-uvularis and the lower margin of the tensor palati. 68 cases of obstructive sleep apnea/hypopnea syndrome had been treated with H-UPPP between September 1998 and May 2001. RESULTS: Polysomnography was performed for all 68 cases 6 months postoperatively with a surgical response of 69.12%, defined as a >50% reduction of the apnea-hypopnea index and <20 apneic pauses/h; no palatopharyngeal incompetency or palatopharyngeal stenosis. Anatomic measurements showed that the preserved uvula in H-UPPP begins to retract 2 weeks postoperatively, and the preserved uvula becomes 'normal' in 3-6 months. CONCLUSIONS: These results suggest that H-UPPP is an effective surgery and produces fewer complications compared with the classic UPPP.     

Hyoidthyroidpexia: a surgical treatment for sleep apnea syndrome

OBJECTIVES/HYPOTHESIS: The aim of this study is to evaluate the results of primary hyoidthyroidpexia (HTP) and HTP after previous uvulopalatopharyngoplasty (UPPP) in patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: Prospective case series. METHODS: Thirty-one patients with obstruction at tongue base level and moderate to severe sleep apnea syndrome underwent HTP. Seventeen patients underwent surgery after an unsuccessful UPPP (secondary HTP), and in 14 patients, primary HTP was performed. RESULTS: Patients who underwent primary HTP showed a significant decrease in apnea hypopnea index (AHI) (P = .007), whereas those patients who had secondary HTP did not (P = .06). Overall, the AHI significantly changed (P = .0005). Visual analogue scales for snoring and hypersomnolence and the Epworth sleepiness scores showed significant improvement for both groups, without any difference between them. HTP was considerably less painful when compared with UPPP. CONCLUSION: This study demonstrates that HTP, in particular as primary treatment in cases of obstruction at tongue base level, is a valuable addition to the therapeutic armamentarium of moderate to severe OSAS. Selection criteria are moderate to severe OSAS with preferably a body mass index less than 27, multilevel obstruction with emphasis on the base of tongue, small tonsils, and normal uvula, without a floppy epiglottis or a palatal stenosis after UPPP.     

阻塞性睡眠呼吸暂停低通气综合征患者手术前后口咽腔测量分析

OBJECTIVE: To explore the relationship between the extent of enlarged oropharynx and efficiency through measuring the anterior-posterior and transverse diameter of oropharynx of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) before and after uvulopalatopharyngoplasty (UPPP). METHODS: Thirty eight patients with OSAHS were studied. The following indexes were measured before and after UPPP: width of uvula base, length of uvula, distance between uvula and posterior pharyngeal wall (DBUP), distance between anterior pillar (DBPP), apnea-hypopnea index (AHI), body mass index (BMI) and SaO2. RESULTS: The preoperative DBAP and DBPP were significantly less than those of normal adults (P < 0.05). DBUP, length of uvula and width of uvula base has no significant difference between preoperative patients and normal adults (P > 0.05). There was no significance difference in DBAP. DBPP and DBUP between postoperative patients and normal adults (P > 0.05). The preoperative AHI, IBM, minimal SaO2, mean SaO2, DBUP, DBPP, DBAP, length of uvula and width of uvula base has no significant difference between good responders and nonresponders (P > 0.1). CONCLUSIONS: Transverse diameter of OSAHS patients is shorter than that of normal adults but anterior-posterior diameter of OSAHS patients has no difference compared with normal adults. Transverse diameter could be enlarged by UPPP. Not only anatomical abnormality but also other factors will contribute to the effect of UPPP.     

阻塞性睡眠呼吸暂停低通气综合征患者悬雍垂腭咽成形术后多导睡眠监测观察指标的比较

目的：探讨阻塞性睡眠呼吸暂停低通气综合征（0sAHs）患者悬雍垂腭咽成形术（UPPP）后PSG观察指标的改变。方法：对行UPPP手术的20例OSAHS患者于手术前后分别进行PSG监测。结果：①与术前比较,UPPP术后PSG监测观察指标中睡眠呼吸暂停低通气指数（AHI）（P〈0．01）、最低SaO2（P〈0．01）、平均SaO2（P〈0．01）、平均睡眠呼吸暂停低通气时间（P〈0．05）,均有不同程度的改善;②UPPP手术后,PSG监测观察指标睡眠时相构成比的改变主要在与从S1期转入到S2期;③PSG监测观察指标中,AHI与最低SaO2、平均SaO2、平均最长睡眠呼吸暂停低通气时间之间均具有相关性,但是前两者之间的相关性更有统计学意义,且手术前后AHI的减小值与最低SaO2的升高值之间同样具有相关性。结论：对于患者病情轻重以及手术疗效的评价,SaO2是较睡眠呼吸暂停低通气时间更为敏感的指标,UPPP术后睡眠构成比的变化主要在于从S1期转入到S2期。     

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。     

Uvulopalatopharyngoplasty for obstructive sleep apnea: a community's experience.

Uvulopalatopharyngoplasty (UPPP) has become an accepted method for treating obstructive sleep apnea (OSA), with a reported success rate as high as 77%, depending upon inclusionary and outcome criteria. The authors reviewed the records of 90 patients with moderately severe OSA (apnea plus hypopnea index [AHI] greater than 20) who underwent UPPP at either a private community or an academic hospital. Forty percent of patients experienced more than a 50% reduction in their AHI with UPPP. Only 22 (24%) of the patients had a postoperative AHI less than 50% of the preoperative AHI and less than 20, i.e., met the authors' criteria for surgical success. The success rate for community otolaryngologists was no different than that achieved in the academic institution. When data from previously published reports were analyzed using these criteria for success, similar results were observed. This study suggests that the effectiveness of UPPP performed by the general otolaryngologic community is equivalent to that reported in the literature. However, more rigorous criteria must be applied to UPPP when evaluating its results and in counseling potential candidates for this procedure.     

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。     

悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停综合征70例分析

目的 :探讨提高悬雍垂腭咽成形术 (UPPP)疗效、减少并发症的方法。方法 :阻塞性睡眠呼吸暂停综合征 (OSAS)患者 70例 ,经全夜 7h多导睡眠图监测确诊 ,33例局麻下完成 U PPP;37例在全麻下完成 ,其中 2 1例行改进的预防性气管切开术。结果 :术后随访半年 ,治愈 13例 (19% ) ,显效 2 5例 (36 % ) ,改善 17例 (2 4% ) ,无效 15例 (2 1% ) ,总有效率为 79%。术中出现高血压危象 2例 ,呼吸障碍 4例 ;术后扁桃体出血 2例 ,全麻拔管后立即出现 度呼吸困难 1例 ,伤口裂开 2例 ,暂时性腭咽功能不全 9例。结论 :提高疗效、减少并发症的措施包括 :扩大软腭成形范围 ;重视软腭后区咽侧壁、腭帆间隙的脂肪组织的切除及腭帆张肌和提肌的保护 ,悬雍垂的部分保留 ;阻塞部位的术前确定 ;麻醉方法与预防性气管切开术的正确选择。改进的气管切开方法换管时方便、安全。     

低温等离子辅助软腭外展加折叠术治疗阻塞性睡眠呼吸暂停低通气综合征

目的　探讨腭咽成形术的改良手术方法,在解除腭咽部解剖性狭窄的同时,通过软腭外展增强软腭紧张度,避免睡眠中软腭功能性塌陷,提高手术疗效。方法 手术治疗以腭咽部狭窄、软腭松弛为主的阻塞性睡眠呼吸暂停低通气综合征患者55例（重度43例,中度12例）,利用软腭两侧斜三角形以及悬雍垂软腭交界处横矩形黏膜瓣切口,在低温等离子刀辅助下,解剖切除双侧腭帆间隙及软腭前方间隙内肥厚黏膜及沉积的脂肪组织,同时行黏膜切缘连同深部肌肉拉拢缝合,缝合后使软腭向两侧外展,悬雍垂-软腭前倾。分别于术前及术后6个月进行Epworth嗜睡量表评分及多道睡眠图监测,对所获得的资料进行统计学分析。结果　55例患者中,治愈8例,显效41例,有效3例,无效3例,手术成功率89.1%。术后Epworth嗜睡量表评分、呼吸暂停低通气指数、最低动脉血氧饱和度与术前比较均有显著性差异（P <0.001）。未出现术后开放性鼻音、长期饮食反流、鼻咽腔瘢痕性狭窄等并发症。结论　低温等离子辅助下软腭外展加悬雍垂-软腭折叠术,使软腭向两侧牵拉外展,悬雍垂及软腭前倾,软腭紧张度增加,可有效解除软腭塌陷,手术疗效满意,无严重并发症发生。     

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

目的改进传统的悬雍垂腭咽成形术（uvul opalatopharyngoplasty,UPPP）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,探讨减少术后并发症的方法。方法对68例OSAHS患者行改良UPPP。手术要点：维持咽腔正常解剖生理形态,保留悬雍垂,切除腭帆间隙脂肪组织,对软腭和咽侧壁进行成形,充分扩大咽腔。术后随访6个月以上,12个月时行多道睡眠图（polysomnography,PSG）监测。结果患者憋气、打鼾、嗜睡等症状均于6个月内明显减轻或消失,术后12个月经PSG监测,其有效率为95.6%。结论改良UPPP可充分扩大咽腔空间,避免并发症,提高手术效果。     

阻塞性睡眠呼吸暂停低通气综合征的改良术式

目的 改良悬雍垂腭咽成形术方法,保留悬雍垂,对软腭和咽侧壁进行处理和成形。 方法 手术治疗阻塞性睡眠呼吸暂停低通气综合征患者263例。手术改 良方法要点：维持咽腔正常解剖生理形态,保留悬雍垂,切除腭帆间隙脂肪组织,对软腭和咽侧壁进行成形, 以充分扩大咽峡和鼻咽峡。 应用多导睡眠图分析,术后随访6个月以上,对术前和术后资料进行统计学分析。结果 263例患者均进入结果分析。(1) 术后不需镇痛药197例(74.9%),需要镇痛药66例(25.1%),咽侧壁光滑168例(63.9%),部分裂开95例(36.1%),术后均无憋气及鼻腔返流等并发症; (2) 均随访6个月以上,无吞咽返呛、开放性鼻音等并发症。95例(36.1%)有咽部异物感,189例(71.9%)睡眠呼吸暂停症状消失,74例(28.1%)仍有症状,但均较术前改善。 术后口腔形态满意252例(95.8%),不满意11例(4.2%); (3) 术前与术后多导睡眠监测结果各项指标比较, 差异均有统计学意义(P均<0. 05)。 结论 改良悬雍垂腭咽成形术可充分扩大咽腔空间,避免并发症,提高手术疗效。     

鼻腔结构重建术用于悬雍垂腭咽成形术后无效患者的治疗

目的探讨鼻腔结构重建术治疗悬雍垂腭咽成形术（UPPP）后无效的阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的疗效。方法选择35例UPPP后无效的OSAHS患者接受鼻腔结构重建术治疗。比较治疗前、后呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSa02）、鼾声评级、Epworth嗜睡量表（EpworthSIeepinessscore,ESS）、鼻阻力和视觉模拟量表（visual analogue scale,VAS）评分,评价治疗效果。结果治疗总有效率为65.7％。患者治疗后6个月,鼾声评级的降低较治疗前无显著差异,ESS评分较治疗前降低非常明显（P〈0．01）,AHI较治疗前减低明显（P〈0.05）,LSa02较治疗前升高明显（P〈0．05）,鼻阻力和VAS评分均明显减小（P〈0．05）。结论对UPPP后无效的OSAHS患者,鼻腔结构重建术是一种有效的补救性治疗方法。