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。

Necessity of preservation of uvulain uvulopaloto-pharyngoplasty]

OBJECTIVE: To explore the necessity and feasibility of the modified uvulopalotopharyngoplasty (UPPP) with uvula reserved completely, and to improve the traditional UPPP. METHODS: Sixty patients with the obstructive sleep apnea-hypopnea syndrome (59 men, 1 women) were diagnosed by polysomnography. The patients were operated under general anesthesia and the uvula was preserved completely in UPPP. Cut the fat from the velopharyngeal space so as to enlarge the the oropharyngeal cavitity. RESULTS: Most of patients reported improvement of main symptoms. The sleeping patients' oxygen saturation was determined 8 days after operation, the oxygen saturation of the patients lying on the side is 90% or even more, and 87% or even more for the ones lying on the back. The judging criterion is that the AHI(apnea-hypopnea index) decrease to 50% of its original level, the validity ratio is 83% 6 months after operation. 2 weeks after operation, the completely preserved uvula began to contract. 3 months after operation, the uvula contracted to the normal length and the anatomical shape of the pharyngeal cavity became normal. This approach avoids velopalatal insufficiency. CONCLUSION: Completely preserving the uvula in the UPPP is feasible and imperative.