腭帆间隙解剖学研究与腭咽成形术

目的 研究软腭解剖学,探讨腭咽成形术中病变组织的切除及正常结构的保护,指导手术方式的改良。方法 测量阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apneahypopnea syndrome,OSAHS) 患者软腭解剖参数71例,非OSAHS成人软腭解剖参数30例;于手术中解剖OSAHS患者部分软腭组织71例,观察OSAHS患者软腭的形态学变化、脂肪及肌肉的分布;取尸体软腭标本6例,行轴位及矢状位连续切片观察。结果 OSAHS患者软腭较正常人明显增长,是形成气道狭窄的重要解剖学基础;软腭粘膜于游离缘折返处、悬雍垂肌与腭帆张肌及腭帆提肌交界处粘膜下组织疏松,是OSAHS患者脂肪沉积的主要部位,有重要的临床意义,将其命名为腭帆间隙。结论 腭帆间隙因OSAHS患者脂肪沉积而扩大,该间隙脂肪组织切除不仅可缩短软腭、扩大咽腔,同时可提高软腭张力,并对软腭功能无明显影响。

Anatomical study of space veli palatine and uvulopalatopharyngoplasty

Objective The study aimed to improve the efficacy of uvulopalatopharyngoplasty (UPPP), especially anatomically based on sofe palate, for obstructive sleep apnea. Methods We compared parameters of sofe palate in 71 OSAHS patients with those of 30 cases matched control group.As all the patients underwent UPPP, we could describe changes in sofe palate morphology and distributions of fat and muscles.And executed and observed slices of sofe palate from six ashes. Results The greater length of sofe palate in the patients with obstructive sleep apnea hypopnea syndrome plays a important role in the pathology of obstruction of the upper airway.And we found a so-called space veli palatine, which is arounded and shaped by uvulavis,tensor veli palatine and levator veli palatine and filled with adipose tissue deposition. Conclusion The preliminary results of the study suggested that a new surgical procedure, fat tissue volumetric reduction in clearance veli palatine for the upper airway obstruction, generally produce an effective extension of the pharyngeal space and good therapeutic results.