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背景:传统悬雍垂腭咽成形术式切除部分软腭、悬雍垂和多余的咽侧壁软组织,虽然改善了症状,但部分患者出现腭咽关闭不全、咽腔瘢痕挛缩等并发症,且远期疗效欠佳。目的:观察悬雍垂腭咽成形术中扩大咽峡和鼻咽峡的特点,分析治疗阻塞性睡眠呼吸暂停低通气综合征的疗效。设计:病例观察。单位:青岛大学医学院附属市立医院。对象:选择2001-07/2006-02以睡眠时打鼾、呼吸暂停、憋气、白天嗜睡等症状来青岛大学医学院附属市立医院睡眠呼吸障碍诊疗中心就诊,经多导睡眠图确诊为阻塞性睡眠呼吸暂停低通气综合征患者216例。术前均确定阻塞部位在口咽部,其鼻咽峡较小及舌根无肥大。呼吸暂停和低通气指数≥5次/h。年龄≥25岁,其中男159例,女57例。方法:改良传统悬雍垂腭咽成形术手术方法,维持咽腔正常生理解剖形态,保留悬雍垂,沿腭舌弓切口向软腭方向做斜行直切口,避免倒“U”型切口。对软腭和咽侧壁进行成形,以充分扩大咽峡和鼻咽峡。主要观察指标:①近期效果观察:术后不需要镇痛药物者为轻度疼痛,需使用镇痛药物者为重度疼痛。口腔侧壁在愈合后能保持咽腔设计形态者为愈合好,反之为愈合差。②远期效果观察:根据患者自述来确定患者有无鼻腔返流、咽部异物感等并发症。根据患者家属的观察及多导睡眠监测,来确定患者有无睡眠呼吸暂停症状。经口咽部检查以确定咽腔形态是否接近正常生理结构。结果:216患者均进入结果分析。①216例患者术后不需镇痛药156例(72%),需要镇痛药者60例(28%);咽侧壁光滑者136例(63%),部分裂开者80例(37%)。术后均无憋气及鼻腔返流等并发症。②216例均随访6个月以上,均无吞咽返呛、开放性鼻音等并发症;84例(39%)患者有咽部异物感;169例(78%)睡眠呼吸暂停症状消失,47例(22%)仍有症状,但均较术前改善。术后口腔形态满意203例(94%),13例(6%)不满意。③术前与术后多导睡眠监测结果各项指标比较差异有显著性[呼吸暂停指数:35.45±16.42,12.75±9.62;低通气指数:19.39±9.86,17.43±10.15;呼吸暂停低通气指数:54.29±18.13,28.31±16.23;平均低血氧饱和度:(83.58±7.96)%,(85.53±8.18)%;平均血氧饱和度:(91.98±3.29)%,(93.01±3.02)%,P均<0.05]。结论:改良传统悬雍垂腭咽成形术式可充分扩大咽腔空间,避免了并发症,患者症状得到明显改善
Background: Traditional uvulopalatopharyngoplasty resection of soft palate, uvula and excess pharyngeal soft tissue, although the improvement of symptoms, but some patients with velopharyngeal insufficiency, pharyngeal scar contracture and other complications, and far Poor efficacy. Objective: To observe the characteristics of enlarged pharyngeal gorge and nasopharyngeal gorge during uvulopalatopharyngoplasty and analyze the curative effect of obstructive sleep apnea-hypopnea syndrome. Design: Case observation. Unit: Qingdao University Medical College Affiliated Municipal Hospital. PARTICIPANTS: Patients with sleep-disordered breathing at the Municipal Hospital of Qingdao University Medical College were selected for treatment of snoring during sleep, apnea, suffocation, daytime sleepiness and other symptoms during 2001-07 / 2006-02. Obstructive sleep apnea was confirmed by polysomnography 216 patients with hypoventilation syndrome suspended. Preoperative occlusion were identified in the oropharyngeal part of the nasopharyngeal gorge smaller and tongue hypertrophy. Apnea and hypopnea index ≥ 5 times / h. Aged 25 years or older, including 159 males and 57 females. Methods: The traditional method of uvulopalatopharyngoplasty was modified to maintain the normal physiological anatomy of the pharyngeal cavity. The uvula was preserved. Oblique straight incision was made along the palatal tongue incision to the soft palate to avoid “U” incision. The soft palate and pharyngeal wall forming, to fully expand the pharyngeal gorge and nasopharyngeal gorge. MAIN OUTCOME MEASURES: (1) The recent observation of the effect: postoperative analgesics do not need those who are mild pain, painkillers need to be used for severe pain. Oral wall in the healing of the pharyngeal cavity to maintain the design of those who form a good healing, on the contrary, poor healing. ② long-term effect of observation: According to patient readme to determine whether patients with nasal reflux, throat foreign body sensation and other complications. According to the patient’s family members and polysomnography monitoring, to determine whether the patient with sleep apnea symptoms. Oral pharyngeal examination to determine whether pharyngeal morphology is close to normal physiological structure. Results: All 216 patients entered the result analysis. ① 216 patients did not need analgesics 156 cases (72%), analgesics need 60 cases (28%); smooth pharyngeal wall in 136 cases (63%), partial dehiscence 80 cases (37% ). No postoperative suffocation and nasal reflux and other complications. ② 216 cases were followed up for more than 6 months, no swallowing back choke, open nasal complication; 84 (39%) patients had pharyngeal foreign body sensation; 169 cases (78%) sleep apnea symptoms disappear, 47 cases 22%) still had symptoms, but all improved compared with preoperative. 203 cases (94%) satisfied the postoperative oral morphology, and 13 cases (6%) were not satisfied. (3) There was significant difference between preoperative and postoperative polysomnography (P <0.05); the index of apnea was 35.45 ± 16.42 and 12.75 ± 9.62; the hypoventilation index was 19.39 ± 9.86,17.43 ± 10.15; the apnea hypopnea index was 54.29 ± 18.13 and 28.31 ± 16.23 respectively. Mean hypoxemia was (83.58 ± 7.96)% and (85.53 ± 8.18)% respectively. Mean oxygen saturation was (91.98 ± 3.29)%, (93.01 ± 3.02)%, P All <0.05]. Conclusion: The modified traditional uvulopalatopharyngoplasty method can fully expand the space of the pharyngeal cavity, to avoid complications, the patient’s symptoms have been significantly improved