改良悬雍垂腭咽成形术联合鼻腔手术治疗阻塞性睡眠呼吸暂停综合征38例

目的探讨改良悬雍垂腭咽成形术（H—UPPP）联合鼻腔手术（下鼻甲骨黏膜下切除术、鼻中隔矫正术）治疗中、重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的效果。方法对中、重度OSAHS患者（有腭咽和鼻腔平面阻塞）38例半随机按入住床位分为A、B两组。A组先行H-UPPP术，后行鼻腔手术；B组相反。术后1—6个月复查鼻声反射、鼻通气阻力和PSG。所有结果用SPSS10.0软件行统计分析。结果所有患者6个月之后，打鼾、憋气、头痛及嗜睡等症状均明显减轻或消失。两组各阶段手术后呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSaO2）、呼吸暂停低通气时间指数（AHTI）较术前均有明显改善，差异有统计学意义（P〈0．01）；鼻腔通气道重建术后，鼻声反射结果提高、鼻通气阻力测试结果减小（P〈0．01）。结论H—UPPP扩大了软腭成形的范围及咽部左右径和前后径；术中无腭咽关闭不全或闭锁发生；单独施行H—UPPP或鼻腔手术均能改善AHI、LSaO2和AHTI，联合治疗更能显著提高疗效。先行鼻腔手术尤能增加行H-UPPP时的麻醉方便和安全。

Effect of H-UPPP and nasal operations on obstructive sleep apnea syndrome in 38 cases

Objective To explore the effect of H-uvulopalatopharyngoplasty （H-UPPP） and nasal cavity aerated and volume extension（NCAVE） in treatment of medium and severe obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods 38 cases （male 28 and female 10）, aging from 24 to 76 years old （average 46.18） were diagnosed by polysoumography （PSG） as medium or severe OSAHS from Jan. 2005 to Sep. 2006 in our hospital. They were semi-randomly divided into groups A and B. BMI, Friedman degree, nasal acoustic reflection and nasal airway resistance were all not statistically different between the two groups. Group A was first treated by H-UPPP and then NCAVE including inferior turbinate bone resection and nasal septal reconstruction, and group B was first treated by NCAVE and then H-UPPP. The tests were rechecked at the end of the 1st or the 6th month after the operations. All parameters were analyzed by software SPSS 10.0. Results Clinical manifestations such as snoring, suffocating, headache, drowsiness, etc. were apparently mitigated or eliminated in 6 months after the operations. Based on the Hangzhou standard, 7 cases were cured, 27 cases had an effect, and the total response rate was 97.37%. Pre-operative levels of AHI, LSaO2 and AHTI were statistically different from post-operative levels. Nasal acoustic reflection was increased from 10.14 ± 3.54 cm^3 to 15.03 ± 3.29 cm^3 and nasal airway resistance was decreased from 0.64 ±0.53 Pa· s/cm^3 to 0.20 ± 0.14 Pa· s/cm^3 （ P 〈 0.01）. Velopharyngeal close insufficiency or atresia was not found. Conclusions H-UPPP enlarges pharyngeal left-right and anterior-posterior diameters. Either H-UPPP or NCAVE could improve the AHI, LSaO2 and AHTI levels, however, combined together they can give a better effect.