CAJ | 학술논문

目的探讨舌骨甲状软骨悬吊联合悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)治疗重症阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的手术方法和效果.方法对69例有舌咽平面和腭咽平面狭窄的重症OSAHS患者[呼吸暂停低通气指数(apnea hyponea index,AHI)＞30次/h]进行了舌骨甲状软骨悬吊联合悬雍垂腭咽成形术.61例完成术后6个月随访,48例完成术后12个月随访.比较手术前后睡眠呼吸监测结果和Epworth嗜睡量表评分.结果 69例患者手术后打鼾症状减轻或消失.术后6个月18例纤维喉镜观察发现,12例患者的腭咽平面和舌咽平面狭窄减轻,6例没有明显变化,但没有舌根后坠.1年后14例纤维喉镜观察未发现狭窄加重者.以AHI降低幅度≥50%为治疗有效的评定标准,术后6个月和12个月随访,有效率分别为78.7%(48/61)和75.0%(36/48);患者AHI平均值由44.8次/h降至15.1次/h和17.2次/h,最低动脉血氧饱和度平均值由0.512升至0.880和0.730,配对t检验,差异均有统计学意义(P值均＜0.01);Epworth嗜睡量表评分平均值分别为6.7和7.2分,均较术前的16.6分明显降低(P值均＜0.01).结论舌骨甲状软骨悬吊联合悬雍垂腭咽成形术方法简单,时间短,花费少,手术效果满意,适用于腭咽平面和舌咽平面狭窄的OSAHS患者的治疗.
목적 탐토설골갑상연골현조연합현옹수악인성형술(uvulopalatopharyngoplasty,UPPP)치료중증조새성수면호흡잠정저통기종합정(obstructive sleep apnea hypopnea syndrome,OSAHS)적수술방법화효과.방법 대69례유설인평면화악인평면협착적중증OSAHS환자[호흡잠정저통기지수(apnea hyponea index,AHI)＞30차/h]진행료설골갑상연골현조연합현옹수악인성형술.61례완성술후6개월수방,48례완성술후12개월수방.비교수술전후수면호흡감측결과화Epworth기수량표평분.결과 69례환자수술후타한증상감경혹소실.술후6개월18례섬유후경관찰발현,12례환자적악인평면화설인평면협착감경,6례몰유명현변화,단몰유설근후추.1년후14례섬유후경관찰미발현협착가중자.이AHI강저폭도≥50%위치료유효적평정표준,술후6개월화12개월수방,유효솔분별위78.7%(48/61)화75.0%(36/48);환자AHI평균치유44.8차/h강지15.1차/h화17.2차/h,최저동맥혈양포화도평균치유0.512승지0.880화0.730,배대t검험,차이균유통계학의의(P치균＜0.01);Epworth기수량표평분평균치분별위6.7화7.2분,균교술전적16.6분명현강저(P치균＜0.01).결론 설골갑상연골현조연합현옹수악인성형술방법간단,시간단,화비소,수술효과만의,괄용우악인평면화설인평면협착적OSAHS환자적치료.
Objective To discuss the methodology and therapeutic effect of hyoid suspension in association with uvulopalatopharyngoplasty ( UPPP) in the treatment of severe obstructive sleep apnea hypopnea syndrome (OSAHS).Methods Sixty-nine patients with severe OSAHS( apnea hyponea index,AHI ＞ 30) were treated with hyoid suspension and UPPP.Sixty-one patients were followed for 6 months (48 of them for 12 months).Polysomnogram (PSG) tests were performed and an Epworth sleepiness scale ( ESS) was recorded preoperatively and postoperatively in these patients.Results After the surgery,the snoring of the patients disappeared or was alleviated to varing degrees.Eighteen patients underwent fiberoptic nasopharyngolaryngoscopic examination.Twelve of them showed palatopharyngeal and glossopharyngeal stenosis was improved 6 months after surgery.Six patients showed no change,but had no glossoptosis.Fourteen patients underwent fiberoptic nasopharyngolaryngoscopic examination 1 year after surgery,with no recurrence of the stenosis being found.A decrease of 50% in the AHI was considered effective,and in patients the effective rate was 78.7% (48/61 ) 6 months after the operation and 75.0% (36/48) 1 year after the operation.The average AHI decreased from 44.8 to 15.1 and 17.2,and the minimum arterial oxygen saturation average increased from 0.512 to 0.880 and 0.730.Matching t tests were utilized and the results of follow-up indicated that there was a significant improvement in the indexes in those cases which could be followed up ( P ＜ 0.01 ).The average of the ESS was 6.7 six months after operation and 7.2 one year after operation,with a significant decrease compared to the preoperative ( 16.6) data (P ＜0.01).Conclusions Modified hyoid suspension in association with UPPP has the advantage of a simple operation,short hospitalization and less expense,and the effect of the operation was significant.Patients with palatopharyngeal and glossopharyngeal stenosis should be chosen for this operation.