中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2010年
5期
377-381
,共5页
康全清%郑国玺%侯瑾%刘海琴
康全清%鄭國璽%侯瑾%劉海琴
강전청%정국새%후근%류해금
睡眠呼吸暂停,阻塞性%舌切除术%耳鼻喉外科手术%治疗结果
睡眠呼吸暫停,阻塞性%舌切除術%耳鼻喉外科手術%治療結果
수면호흡잠정,조새성%설절제술%이비후외과수술%치료결과
Sleep apnea,obstructive%Glossectomy%Otorhinolaryngologic surgical procedures%Treatment outcome
目的 观察舌后部中线切除术联合悬雍垂腭咽成形术(UPPP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的远期疗效.方法 回顾性分析24例2003年1月至2004年3月实施上述手术且有连续5年多道睡眠图(PSG)监测随访资料的重度OSAHS患者.患者术前夜间最低动脉血氧饱和度(SaO2)中位数(下同)0.650,AHI中位数56.5次/h,均于全麻下接受手术,围手术期均未行气管切开.疗效判定标准:AHI<5次/h为治愈,AHI<20次/h且降低幅度≥50%为显效,AHI降低幅度≥50%为有效.结果 24例患者术后0.5、1、2和5年AHI以及最低SaO2的中位数与术前相比.差异均有统计学意义(Wilcoxon秩和检验,下同,P值均<0.01);术后1、2与5年AHI和最低SaO2的中位数与术后半年相比差异也均有统计学意义(P值均<0.01).24例患者中术后半年治愈21例,显效3例,治愈率87.5%;术后1年,治愈18例,显效3例,有效3例,治愈率75.0%;术后2年,治愈14例,显效4例,有效6例,治愈率58.3%;术后5年治愈6例,显效12例,有效4例,无效2例,治愈率25%,有效率91.7%.术前5例合并高血压患者,4例术后停止应用降压药,1例由三种降压药联合应用减为单种药物,血压控制平稳.结论 舌后部中线切除联合UPPP手术可有效治疗腭后区及舌后区狭窄为主的重度OSAHS,虽有不同程度的复发现象,远期疗效还比较好.
目的 觀察舌後部中線切除術聯閤懸雍垂腭嚥成形術(UPPP)治療阻塞性睡眠呼吸暫停低通氣綜閤徵(OSAHS)的遠期療效.方法 迴顧性分析24例2003年1月至2004年3月實施上述手術且有連續5年多道睡眠圖(PSG)鑑測隨訪資料的重度OSAHS患者.患者術前夜間最低動脈血氧飽和度(SaO2)中位數(下同)0.650,AHI中位數56.5次/h,均于全痳下接受手術,圍手術期均未行氣管切開.療效判定標準:AHI<5次/h為治愈,AHI<20次/h且降低幅度≥50%為顯效,AHI降低幅度≥50%為有效.結果 24例患者術後0.5、1、2和5年AHI以及最低SaO2的中位數與術前相比.差異均有統計學意義(Wilcoxon秩和檢驗,下同,P值均<0.01);術後1、2與5年AHI和最低SaO2的中位數與術後半年相比差異也均有統計學意義(P值均<0.01).24例患者中術後半年治愈21例,顯效3例,治愈率87.5%;術後1年,治愈18例,顯效3例,有效3例,治愈率75.0%;術後2年,治愈14例,顯效4例,有效6例,治愈率58.3%;術後5年治愈6例,顯效12例,有效4例,無效2例,治愈率25%,有效率91.7%.術前5例閤併高血壓患者,4例術後停止應用降壓藥,1例由三種降壓藥聯閤應用減為單種藥物,血壓控製平穩.結論 舌後部中線切除聯閤UPPP手術可有效治療腭後區及舌後區狹窄為主的重度OSAHS,雖有不同程度的複髮現象,遠期療效還比較好.
목적 관찰설후부중선절제술연합현옹수악인성형술(UPPP)치료조새성수면호흡잠정저통기종합정(OSAHS)적원기료효.방법 회고성분석24례2003년1월지2004년3월실시상술수술차유련속5년다도수면도(PSG)감측수방자료적중도OSAHS환자.환자술전야간최저동맥혈양포화도(SaO2)중위수(하동)0.650,AHI중위수56.5차/h,균우전마하접수수술,위수술기균미행기관절개.료효판정표준:AHI<5차/h위치유,AHI<20차/h차강저폭도≥50%위현효,AHI강저폭도≥50%위유효.결과 24례환자술후0.5、1、2화5년AHI이급최저SaO2적중위수여술전상비.차이균유통계학의의(Wilcoxon질화검험,하동,P치균<0.01);술후1、2여5년AHI화최저SaO2적중위수여술후반년상비차이야균유통계학의의(P치균<0.01).24례환자중술후반년치유21례,현효3례,치유솔87.5%;술후1년,치유18례,현효3례,유효3례,치유솔75.0%;술후2년,치유14례,현효4례,유효6례,치유솔58.3%;술후5년치유6례,현효12례,유효4례,무효2례,치유솔25%,유효솔91.7%.술전5례합병고혈압환자,4례술후정지응용강압약,1례유삼충강압약연합응용감위단충약물,혈압공제평은.결론 설후부중선절제연합UPPP수술가유효치료악후구급설후구협착위주적중도OSAHS,수유불동정도적복발현상,원기료효환비교호.
Objective To observe the long-term results of midline partial glossectomy with uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). Methods Twenty-four severe OSAHS patients treated with midline partial glossectomy and UPPP from January 2003 to March 2004 were included in this study, the follow-up was 5 years. The median of preoperative lowest arterial oxygen saturation ( LSaO2) of this group at night (the same below) 0. 650, and AHI was 56. 5 times/h, UPPP was performed under general anesthesia, no tracheotomy performed. Criteria of curative effects; AHI <5 times/h was recovery, AHI <20 times/h and decreased beyond 50% marked improvement, only AHI decreased beyond 50% improvement. Results Post-operation AHI (6 months, 1 year, 2 years and 5 years after surgery) decreased significantly compared to that before the surgery, and post-operation LSaO2 was significantly higher than that of preoperative (Wilcoxon's signed rank test, the same below, P <0.01). The LSaO2 and AHI were significantly different between 1 year, 2 years, 5 years and 6 months post-operatively (P <0. 01). Six months after surgery, PSG results showed that 21 were recovery, marked improvement for the other 3 cases, the recovery rate was 87. 5%. One year after surgery, 18 were recovery, marked improvement in 3 cases, the recovery rate 75. 0%. Two years after surgery, 14 cases recovery, marked improvement in 4 cases, the recovery rate 58. 3%. Five years after surgery, 6 were recovery, the recovery rate 25. 0%. Among 5 cases with hypertension before the surgery, after surgery antihypertensive drugs were not necessary in 4 cases, and the dosage was decreased in 1 case. Conclusion The midline partial glossectomy with UPPP surgery may be an effective treatment for the severe OSAHS, long-term effect is satisfactory.
