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

Value of preservation of uvula in uvulopalatopharyngoplasty

Objective To explore the effect of the modified Uvulopalatopharyngoplasty (UPPP) where uvula is preserved in the operation, and whether the postoperative complications are diminished. Methods Thirty consecutive patients with the obstructive sleep apnea syndrome (29 men, 1 woman ) were analyzed by questionnaire, polysomnography and oral cavity measurement before and 6 months after uvulopalatopharyngoplasty to assess the surgical outcome and value of preservation of uvula in the operation Results Eighty seven percent of patients reported improvement of snoring and daytime sleepiness Fifty three percent of patients showed a decrease of at least 50% in the apnea and hypopnea indices Among the mild and moderate obstructive sleep apnea (AHI<50),73 3% of them showed a decrease of at least 50% in the AHI No velopalatal insufficiency occurred The result of oral cavity measurement showed that the uvula, which was preserved completely during the operation, began to contract 2 weeks after the operation Three to six month after operation, uvula contracted to the normal length and the anatomical shape of the pharyngeal cavity became normal Conclusions The results of the uvula preserving UPPP indicate that this approach not only improves the effect of the UPPP, but also avoids the postoperative complications The uvula that preserved completely during the operation will contract to the normal length progressively