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。

Uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea syndrome in 70 cases

Objective:To elevate the effect of uvulopalatopharyngoplasty(UPPP)and minimize the postoperative complications.Method:The data of 70 patients with obstructive sleep apnea syndrome diagnosed with polysomnography were analyzed.Result:15 cases (21%) reported unchanged snoring and apnea and hyponea index.55 cases improved after UPPP for at least 6 months.The complications included hypertensive crisis (2 cases),respiratory embarrassment (4 cases)in period of paretic UPPP.After UPPP,The complications included local hemorrhage(1 case),wound dehiscence(2 cases),temporal velopalatal insufficiency (9 cases),one had suffocation after extraction of endotracheal tube.Conclusion:Our results indicate that the strategies of improving the effect and avoiding the complications include:Excision of the lateral pharyngeal wall in retropalatal region and fat tissue in soft palate.Protection of palatosalpingeus and palatostaphylinus.Part preservation of uvula.Confirmation of the obstructive region.Choice of the anesthesia and prventive tracheotomy.Modified tracheotomy were safe and convenient when exchanging trachea canula.