悬雍垂低温等离子去黏膜化并翻转缝合悬吊术在中度OSAHS患者手术中的应用

目的分析悬雍垂低温等离子去黏膜化翻转缝合悬吊术在中度阻塞性睡眠呼吸暂停综合征(OSAHS)患者外科手术中的临床具体应用价值。方法回顾性分析在悬雍垂腭咽成形术（UPPP）基础上对多导睡眠监测(PSG)确诊中度OSAHS患者进行手术方式改良，采取低温等离子去黏膜化并悬雍垂翻转“8”字缝合悬吊固定手术的32例患者临床资料。其中 16例患者为对照组（开展常规H UPPP手术），16例患者为实验组（低温等离子行悬雍垂去黏膜化，悬雍垂翻转“8”字缝合悬吊固定术），所有患者术前行药物诱导睡眠内镜（DISE）检查评估患者上气道阻塞情况，根据 ESS评分、鼾声量表评分对所有患者主观症状及术后并发症发生情况进行评估，并采用SPSS软件进行统计学分析。结果所有患者手术前后比较，术后ESS 评分、鼾声量表评分明显改善，差异具有统计学意义（P<0.05），两组间手术方式ESS 评分、鼾声量表评分比较无统计学意义（P>0.05）；两组间手术时间、术中出血量比较差异具有统计学意义（P<0.05）；两组间术后疼痛评分比较，实验组明显好于对照组，差异具有统计学意义（P<0.05）；实验组术后咽部异物感、咽部干燥、咽部绷紧感与对照组比较，差异均具有统计学意义（P<0.05）；无永久性腭咽关闭不全患者；术后两组患者均无围手术期呼吸困难，无围手术期死亡及术后拔管困难。结论结合低温等离子技术的悬雍垂去黏膜化并翻转缝合悬吊术是针对以腭咽平面、口咽侧壁平面为主要责任平面狭窄及左右狭窄为显著特征的中度OSAHS患者治疗有效的改良手术方法，具有术后反应和主观症状较轻、手术并发症发生率较低的特点，短期疗效确切，值得临床推广。

Application of low temperature plasma removal of uvula mucosa combined with inverted suture and suspension in the surgical treatment of moderate OSAHS

ObjectiveTo analyze the clinical application value of low temperature plasma removal of uvula mucosa combined with inverted suture and suspension in the surgical treatment of moderate obstructive sleep apnea hypopnea syndrome(OSAHS).MethodsClinical data of 32 patients suffering from moderate OSAHS confirmed by polysomnography (PSG) and surgically treated were analyzed retrospectively. All the patients received drug induced sleep endoscopy (DISE) for evaluating the obstruction of upper airway and were equally divided into two groups. The 16 cases of the control group were treated with conventional Han uvulopalatopharyngoplasty (H UPPP), while those of the experimental group received low temperature plasma removal of uvula mucosa combined with inverted suture and suspension based on the H UPPP. Their subjective symptoms and postoperative complications were evaluated according to Epworth sleepiness scale (ESS) and snoring scale scores, and analyzed statistically using SPSS software.ResultsComparisons between preoperative and postoperative ESS score as well as snore scale score showed significant improvement in the patients of both groups, and the differences were all statistically significant (all P<0.05). There were no statistically significant differences in ESS score and snore scale scores between the two groups (all P>0.05). The differences of operative time and intraoperative blood loss between the two groups were statistically significant (both P<0.05). The difference of postoperative pain score between the two groups was statistically significant (P<0.05), and the experimental group was significantly better than the control group. The occurrence rates of postoperative complications including pharyngeal foreign body sensation, pharyngeal dryness and pharyngeal tension in the experimental group were lower than those in the control group, and the differences were all statistically significant (all P<0.05). Permanent palatopharyngeal insufficiency, perioperative dyspnea, perioperative death and postoperative difficult extubation were observed in none of both groups. ConclusionWith advantages of mild postoperative reaction and subjective symptom, low incidence of complication as well as definite short term curative effect, low temperature plasma removal of uvula mucosa combined with inverted suture suspension is worthy to be clinically popularized and applied in the surgical treatment of moderate OSAHS, especially for those with the palatopharyngeal plane and oropharyngeal lateral wall as the main responsibile narrow plane.