悬雍垂腭咽成形术和鼻部手术治疗阻塞性睡眠呼吸暂停低通气综合征

目的对合并鼻部和口咽部阻塞的阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）患者进行鼻部手术和改良悬雍垂腭咽成形术（uvulopalatopharyngoplasty，UPPP），探讨不同手术及不同顺序联合手术对疗效的影响。方法OSAHS诊断和评估手术疗效采用多道睡眠监测（polysomnography，PSG）、Epworth嗜睡量表（Epwoahsleepscore，ESS）评分、体重指数（bodymassindex，BMI）和主观症状。患者按照单、双日的半随机方法分为A、B两组，A组46例先行鼻手术，B组42例先行改良UPPP。术后2个月评估，A、B两组中无效者分别再行UPPP和鼻部手术。两组患者均在最后手术后随访1年以上。结果A组单纯鼻部手术后有效率23．9％（11／46），轻度患者有效率44．0％（11／25），随访1年无复发；其余疗效差的轻度和中度患者共35例均行UPPP，1年后随访检测PSG有效率85．7％（30／35）。B组单纯UPPP有效率47．6％（20／42），轻度者有效率63．6％（14／22），中度有效率30．0％（6／20），1年后随访检测PSG复发4例；其余疗效差的22例再行鼻部手术，1年后有效率86．4％（19／22）。两组总体疗效差异无统计学意义（89．1％和83．3％，P〉0．05）。A、B两组联合手术者与单纯行鼻部手术或UPPP术的有效率差异有统计学意义（P〈0．05）。A、B两组联合手术者有效率差异无统计学意义（85．7％和86．4％，P〉0．05）。结论合并鼻部和口阻塞的OSAHS患者，轻度者可先行单纯鼻部手术，无效或效果差时再行UPPP；中度患者改良UPPP联合鼻部手术可提高有效率。

Treating obstructive sleep apnea with nasal operation and revised uvulopalatopharyngoplasty

OBJECTIVE: Nasal operation and/or H-uvulopalatopharyngoplasty (UPPP) was performed for obstructive sleep apnea hypopnea syndrome (OSAHS) patients with both oral pharynx and nasal obstruction, results analyzed. METHODS: Patients were divided into group A (46 cases) and group B (42 case) randomly. Nasal procedures were: septoplasty, radiofrequency reduction of inferior turbinate, adenoidectomy and functional endoscopic operation. Cases in group A had nasal operation first, while cases in group B first had UPPP. All patients had sleep study with polysomnography (PSG) 2 and 12 months after each operation. Those who failed to reach the criteria of being effective after first surgery (defined as a 25% reduction in baseline apnea hypopnea index (AHI) received second phase operation (nasal operation for group B and UPPP for group A). The response rates were compared between the two groups after each phase of operation. RESULTS: In group A, the phase one operation were effective in 44.0% (11/25) for the mild degree OSAHS patients (defined as AHI < 20/h), according to the sleep study performed 2 months after surgery, and no recurrence after one-year. All moderate ones (defined as 20/h < AHI < 40/h) responded poorly to nasal operation. The overall response rate was 23.9% (11/46). Non-responsers (35 cases) in group A underwent UPPP and the response rate to it was 85.7% (30/35) in one year. In group B, UPPP operation was effective in 63.6% (14/22) mild cases and 30.0% (6/20) moderate cases in 2 months but 4 cases had recurrence in one year. Twenty-two cases underwent the second phase operation of nose and the response rate was 86.4% (19/22) in one year. There was no statistical significance on the overall response rate between group A and B (89.1% vs 83.3%, P > 0.05). While there was statistical significance of response rate between those patients who had only one operation and those who had both surgeries (P < 0.05). CONCLUSIONS: The combination of nasal procedures and UPPP is effective a for OSAHS patient with nasal diseases especially in mild and moderate cases.