咽腔扩大成形术治疗阻塞性睡眠呼吸暂停综合征(附49例报告)

目的：为了治疗阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ），将腭咽成形术加以改良，共行４９例手术。方法：摘除扁桃体，将腭舌弓大部分切除，保留腭咽弓，并将腭咽弓上端向外上４５°剪开，将其向外牵拉缝合；软腭前面较后面多切除约０．６ｃｍ，将后面粘膜向前上牵拉缝合，以扩大咽腔。对舌扁桃体肥大者，彻底切除三角皱襞，将舌根两侧分别向前外牵拉缝合，固定到前创缘。结果：术后咽横截面积由术前的１０３．９４±１５．４１ｍｍ２增加到３５６．２１±１６．４６ｍｍ２。呼吸暂停消失者３２例、减轻１５例，总有效率为９５．９％。结论：改良的腭咽成形术较传统的手术效果为好，尤其对舌扁桃体肥大者也有效。但其适应证仍不包括因各种鼻疾、颌部畸形等所致阻塞性睡眠呼吸暂停综合征。

APPLICATION OF ENLARGED PHARYNGEALCAVITY PLASTY TO OBSTRUCTIVESLEEP APNEA SYNDROME(A REPORT OF 49 CASES)

Objective: To evaluate the effect of modified uvulopalatopharyngoplasty (UPPP). Methods: 49 patients underwent operation. To enlarge the pharyngeal cavity, most portion of the palatoglossal arch was removed, the palatopharyngeal arch was reserved, an incision was made towards 45 direction at its superior site and the palatopharyngeal arch was sutured superioanteriorly. The crosssection of the soft palate was oblique and the anterior incisal margin of the soft palate mucosa was 6mm anterior to that of the posterior margin. The triangular fold was removed in the patients with hypertrophy of lingual tonsil. Results: The transverse arch of pharyngeal cavity was increased from 103.9415.41mm2 preoperatively to 356.2116.46 mm2 postoperatively. The apnea disappeared in 32 cases, decreased in 15 and remained unchanged in 2 cases. The effective rate was 95.9%. Conclusion:WTBZ The modified UPPP has a better effect than traditional operation, especially for patients with hypertrophy of lingual tonsil. But its indication does not include the apnea resulting from rhinol diseases and maxillofacial malformation.