完整保留悬雍垂及软腭游离缘手术治疗阻塞性睡眠呼吸暂停低通气综合征的疗效评价

目的：探讨手术治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）中有效控制术后并发症、提高其疗效的手术方法。方法：将59例Ⅰ型OSAHS患者根据患者意愿分为2组，实验组(39例)采用软腭横向双梭形切口及扩大双扁桃体切除,完整保留悬雍垂及软腭游离缘方法；对照组(20例)行腭咽成形术（UPPP）或保留悬雍垂UPPP,分析比较2组术前、术后多导睡眠呼吸监测(PSG)及术后鼾声评级、Epworth评分结果，术后出现咽痛强度及持续时间、鼻腔返流或误咽、咽腔缩窄发生情况。结果：实验组鼾声有效率为92.31%,对照组有效率为70.00%,2组有效率比较差异有统计学意义（P<0.05)。与术前比较，术后AHI均降低（P<0.05)，平均血氧饱和度升高（P<0.05)，2组间PSG结果差异无统计学意义;术后实验组咽部疼痛与对照组比较程度轻;随访6～12个月,鼾声评分、鼻咽返流或误咽及咽腔缩窄发生率差异有统计学意义(P<0.05)。结论：软腭横向双梭形切口及扩大双扁桃体切除术式治疗OSAHS,既完整保留了悬雍垂，又扩大了软腭成形范围，不仅有效扩大口咽腔通气截面积，而且较好地保留了咽腔的正常生理形态和功能，避免了腭咽关闭不全等并发症的发生。

Evaluation on curative effect of intactly reserving uvula and free edge of soft palate operation in treatment of OSAHS

Objective To enplore the methods to effectively control the postoperational complications and improve the curative effect in treatment of obstructive sleep apneahypopnea syndrome(OSAHS).Methods 59 patients with typeⅠ OSAHS were divided into two groups.The patients in experiment group(39 cases) were treated with soft palate landscape orientation two fusiform cuts and enlarged two amygdales resection;the patients in control group(20 cases) were treated with uvulopalatopharyngoplasty(UPPP) or reserving uvula UPPP.The PSG at preoperation and postoperation,and snore rate,Epworth score at postoperation in two groups were analyzed and compared.The intension and the time of duration of postoperation pharyngalgia,backflow from nasal cavity or missing deglutition,cavum pharyngis stenosis were observed.Results The effective rate in experiment group was 92.31%,in control group was 70.00%,there was significant difference between two groups(P<0.05);compared with preoperation,the AHI was decreased(P<0.05) and the average arterial oxyhemoglobin saturation was increased(P<0.05)after operation.There was no significant difference in PSG between two groups;compared with control group,the degree of pharyngeal ache in experiment group was redeced after operation;after 6-12 months follow-up,there were significant differences in the changes of snore,nasopharynx’ s backflow or missing deglutition and cavum pharyngis stenosis(P<0.05).Conclusion Soft palate landscape orientation two fusiform cuts and enlarged two amygdales resection not only completely reserve uvula,but also enlarge soft palate shaping confines in treatment of OSAHS;not only effectively enlarge the ventilate’ s sectional area of cavum oropharyngeum,but also preferably keep the normal physiological morphology and function of cavum pharynges and avoid the occurrence of complications such as palatepharynx insufficiency,etc.