重度阻塞性睡眠呼吸暂停低通气综合征多平面阻塞同期手术治疗效果评价

摘要/Abstract

摘要： 目的观察存在上气道结构性狭窄的重度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome, OSAHS）鼻、口咽、喉咽多平面阻塞同期手术的治疗效果,探讨提高OSAHS疗效、减少复发的经验。方法 2008年4月—2013年12月,对21例严重OSAHS患者通过临床检查和Alice 5多导睡眠监测仪监测（PSG）,术前睡眠呼吸暂停低通气指数（AHI）58.8~74.0,平均67.8,SaO₂最低0.25~0.67,平均0.46,最长睡眠呼吸暂停时间52~77 s,平均63.3 s。全麻下同期完成鼻腔扩容手术、腭垂腭咽成形术（uvulopalatopharyngoplasty, UPPP）、腭扁桃体切除手术;颏部“开窗”、“凸”形或“梯形”截骨,前徙颏部及颏舌肌和舌骨上肌群的颏前徙术;舌骨下肌群切断、舌骨悬吊术。气管插管维持24~48 h。结果经过8~68个月随访,21例手术创口均一期愈合,睡眠呼吸障碍症状消除或明显减轻,8例打鼾消失,13例仰卧位时仍有轻、中度鼾声,均无睡眠憋醒现象,同期颏成形患者对外形改善满意。PSG监测术后AHI10.2~24.2,平均20.3,SaO₂ 0.82~0.99,平均0.91,最长呼吸暂停时间11~35 s,平均17.9 s。结论存在上气道结构性狭窄的重度OSAHS采取同期多平面手术治疗,可明显提高治疗效果且缩短疗程,经治病例均获得较满意疗效。

关键词: 阻塞性睡眠呼吸暂停低通气综合征, 多平面手术, 腭垂腭咽成形术

Abstract: PURPOSE：To evaluate the effect of multiple plane operations in the treatment of severe obstructive sleep apnea-hypopnea syndrome (OSAHS) and introduce the clinical experience of improving curative effect and reducing recurrence. METHODS: The clinical data of 21 patients with severe OSAHS were retrospectively analyzed. The 21 cases had definite diagnosis by X-ray cephalometry, nasopharyngeal fiberscope, PSG and clinical examination before operation. Preoperative PSG monitoring showed AHI was 58.8-74.0 (mean 67.8), the minimum SaO₂ was 0.25-0.67 (mean 0.46). LOSAT was 52-77 s (mean 63.3 s). All patients underwent two planes operations or more in the same term as below: modification of nasal septum deviation, partial middle turbinectomy and inferior turbinectomy, functional ethmoidectomy or maxillary sinus cystectomy with nasal endoscope, UPPP, tonsillectomy and GAHM. All patients underwent PSG examination and 15 cases were treated by nCPAP before operation. RESULTS: The patients were followed up for 8-68 months, twenty-one cases achieved primary healing and had no waking at night due to suffocating. Clinical symptoms disappeared or relieved markedly. Sleep snoring disappeared in 8 cases, while 13 cases still had slight or moderate snoring. Postoperative PSG monitoring showed AHI was 10.2 -24.2 (mean 20.3), the minimum SaO₂ was 0.82-0.99 (mean 0.91), LOSAT was 11 s- 35 s (mean 17.9 s). CONCLUSIONS: Severe OSAHS with multi-level obstructions in upper airway caliber, such as nasal nasopharyngeal, velo-pharyngeal and tongue-pharyngeal obstruction can be treated by multiple plane operations simultaneously, which can improve the outcome and shorten the treatment course.

Key words: OSAHS, Multiple plane operation, UPPP

中图分类号:

R782.2

刘中寅, 张宗德, 汤晓雨, 赵昊, 冯晓东, 付森博. 重度阻塞性睡眠呼吸暂停低通气综合征多平面阻塞同期手术治疗效果评价[J]. 中国口腔颌面外科杂志, 2015, 13(1): 63-67.

LIU Zhong-yin, ZHANG Zong-de, TANG Xiao-yu, ZHAO Hao, FENG Xiao-dong, FU Sen-bo. Evaluation of multiple plane operations in the treatment of severe obstructive sleep apnea hypopnea syndrome[J]. China J Oral Maxillofac Surg, 2015, 13(1): 63-67.

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