阻塞性睡眠呼吸暂停低通气综合征改良术式.docVIP

阻塞性睡眠呼吸暂停低通气综合征改良术式 　【摘要】 目的 改良悬雍垂腭咽成形术方法，保留悬雍垂，对软腭和咽侧壁进行处理和成形。 方法 手术治疗阻塞性睡眠呼吸暂停低通气综合征患者263例。手术改良方法要点：维持咽腔正常解剖生理形态，保留悬雍垂，切除腭帆间隙脂肪组织，对软腭和咽侧壁进行成形, 以充分扩大咽峡和鼻咽峡。 应用多导睡眠图分析，术后随访6个月以上，对术前和术后资料进行统计学分析。结果 263例患者均进入结果分析。(1) 术后不需镇痛药197例(74.9%)，需要镇痛药66例(25.1%)，咽侧壁光滑168例(63.9%)，部分裂开95例(36.1%)，术后均无憋气及鼻腔返流等并发症； (2) 均随访6个月以上，无吞咽返呛、开放性鼻音等并发症。95例(36.1%)有咽部异物感，189例(71.9%)睡眠呼吸暂停症状消失，74例(28.1%)仍有症状，但均较术前改善。 术后口腔形态满意252例(95.8%)，不满意11例(4.2%)； (3) 术前与术后多导睡眠监测结果各项指标比较, 差异均有统计学意义(P均lt;0. 05)。 结论 改良悬雍垂腭咽成形术可充分扩大咽腔空间，避免并发症，提高手术疗效。 【关键词】 睡眠呼吸暂停 阻塞性 悬雍垂 腭成形术 成形术 sleep apnea hypopnea syndrome Abstract: Objective To modify uvulopalatopharyngoplasty(UPPP). Methods 263 patients with obstructive sleep apnea hypopnea syndrome(OSAHS) were treated with modified UPPP. In the operations, the uvula was reserved, the fat tissues of the palatine velar cleft were dissected and palatoplasty and pharyngoplasty were carried out. All patients was determined by polysomnography(PSG) before the operations and 6 months after the operations to assess the surgical outcome statistically. Results All patients were involved in this analysis. (1) 197(74.9%) patients did not need painkillers after the operations and 66(25.1%) needed painkillers. The lateral pharyngeal wall was smooth in 168(63.9%) cases and was partly split in 95(36.1%) cases. There were no complications such as breath holding or backstreaming in the nasal cavity after the operations. (2) All were followed up for more than 6 months and no deglutitive bucking or open rhinolalia were found. 95(36.1%) patients had pharyngeal foreign body sensation. Syndromes of sleep apnea disappeared in 189 (71.9%) patients and were alleviated in the other 74(28.1%) patients. In 252(95.8%) patients, the postoperative morphous of the oral cavity was content. (3) The PSG results were statistically significant between the preoperative and postoperative for 263 patients（P＜0.05). Conclusions The modified UPPP not only extends the nasopharynx cavity but also avoids postope