U缝合技术在悬雍垂腭咽成形术中应用.docVIP

U缝合技术在悬雍垂腭咽成形术中应用 　 作者：修世国 叶辉 姜宪 金凤 【摘要】 目的改进悬雍垂腭咽成形术(uvulopalatopharyngoplasty, UPPP)的传统缝合技术，探讨U缝合技术在UPPP中的应用效果，提高UPPP的疗效。 方法治疗阻塞性睡眠呼吸暂停低通气综合征（Obstructive sleep apnea hypopnea syndrome, OSAHS）患者86例，随机分为实验组46例，对照组40例。实验组按照改良UPPP术式切除相应组织，U形缝合软腭外侧及咽侧壁；对照组按照改良UPPP术式进行切除及切缘对位缝合。结果实验组主观症状明显改善者占97%，有效率为83%； 对照组分别为89%和70%。结论 此种缝合技术有效地改善了传统缝合技术不可避免的切口裂开、缝线切割等并发症，更为有效地扩大腭后隙的前后径/左右径，减少了因缝合后组织回位造成的治愈率下降问题，提高了UPPP的疗效。 【关键词】 睡眠呼吸暂停低通气综合征 悬雍垂腭咽成形术 缝合技术 　　Abstract：ObjectiveTo improve the conventional suturation skill in uvulopalatopharyngoplasty, and explore the effect of U suturation skill in uvulopalatopharyngoplasty. Methods86 patients with OSAHS were randomly allocated to treatment group (46 cases) and control group (40 cases). Patients in treatment group were operated with improved UPPP, soft palate and lateral pharyngeal wall were stitched with U suturation skill. Patients in control group were stitched with conventional suturation skill.ResultsSubjective symptoms improved in treatment group was 97%, the effective rate was 83% according to AHI decreased ﹥50% after PSG, and those was 89% and 70% in control group respectively.ConclusionU suturation skill can effectively decrease the complication such as disruption of wound or cutting of tissue, enlarge anteroposterior dimension/bilateral dimension behind soft palate, elevate cure rate through UPPP. 　　Key words：Sleep apnea syndromes; Uvulopalatopharyngoplasty; Suturation skill 悬雍垂腭咽成形术(uvulopalatopharyngoplasty, UPPP)是目前广泛应用的治疗阻塞性睡眠呼吸暂停低通气综合征（Obstructive sleep apnea hypopnea syndrome, OSAHS）的方法，但手术成功率一直徘徊在40%～53%左右［1，2］，如何提高手术成功率是亟待解决的问题。除严格选择手术适应证外，手术方法、手术技巧也同样重要。UPPP术后缝线切割组织、切口裂开、牵拉组织回位是常见现象，既影响手术效果，又增加了并发症。为改观这种现象，对缝合技术进行了改进，提高了手术成功率。现将我科200405～200505经UPPP治疗98例患者，其中随访1年以上者86例，报告如下。 　　1 材料与方法 　　1.1 病例选择 　　患者86例，男72例，女14例；年龄19～64岁，平均年龄49岁。随机分为实验组46例，对照组40例。患者以睡眠打鼾及呼吸暂停、白日嗜睡、倦怠、口干等症状就诊。检查见口咽腔狭窄、腭扁桃体Ⅱ～Ⅲ度肿大，纤维喉镜检查均见有明显腭后间隙狭窄，Muller试验（+++～++++），舌根会厌平面Muller试验（+～++）。本研究只观察UPPP的疗效，舌根会厌平面Muller试验（+++～++++）不在手术适应证内。有鼻及鼻咽平面狭窄者先治疗鼻及