等离子辅助悬雍垂腭咽成形术后重度咽狭窄的治疗

目的 分析等离子辅助悬雍垂腭咽成形术(UPPP)后重度咽狭窄形成原因,探讨最适合治疗方案。 方法 等离子辅助UPPP术后重度咽狭窄患者8例(单纯鼻咽狭窄5例,鼻咽和口咽联合狭窄3例),分别采用瘢痕切除、临近黏膜瓣修复创面、口咽狭窄横切纵缝、放置鼻咽支架6个月以上的方法治疗。疗效评估方式,术前和术后的(1)主观症状评分变化;(2)狭窄咽腔扩大情况。 结果 随访1~4.5年,7例术后鼻咽气道最大直径约2 cm,症状评分明显改善,1例术后再狭窄目前佩戴鼻咽支架治疗中。 结论 低温等离子辅助UPPP操作不当可引起严重咽狭窄,通过手术,同时放置鼻咽支架,是较理想的咽狭窄治疗方法。

Treatment of pharyngeal stenosis following uvulopalatopharyngoplasty with coblation.

Objective Pharyngeal stenosis as a postoperative complication following uvulopalatopharyngoplasty(UPPP)with coblation is rare and may be difficult to treat. This report explores the causes of pharyngeal stenosis and presents our experience in successfully treating it. Methods From November 2010 to August 2016, eight patients with pharyngeal stenosis(five cases of nasopharyngeal stenosis and three of combined nasopharyngeal and oropharyngeal stenosis)secondary to UPPP with coblation presenting to Peking Union Medical College Hospital were studied. All patients with grade Ⅲ nasopharyngeal stenosis and different levels of difficulty in nasal breathing, mouth breathing, and blowing of the nose, as well as hyponasal speech, snoring, apnea, anosmia, and dysphagia. They underwent scar resection surgery for nasopharyngeal stenosis, horizontal-to-vertical pharyngoplasty for oropharyngeal stenosis, and local pharyngeal-flap rotation. Nasopharyngeal hollow stents were maintained in situ for >6 months postoperatively. Results Over a follow-up period of 1-4.5 years, amelioration of all symptoms was observed in seven cases, and the nasopharyngeal diameter was maintained at about 2 cm. No case of velopharyngeal insufficiency was noted. One patient required retreatment after restenosis. Conclusion Improper operation with coblation can cause severe postoperative pharyngeal stenosis. Scar resection, local flap rotation, horizontal-to-vertical pharyngoplasty, and prolonged use of nasopharyngeal hollow stents are reliable methods for correction of pharyngeal stenosis following UPPP surgery.