CAJ | 학술논문

目的比较阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者与非OSAHS对照者舌动脉走行规律及测量参数的异同,指导中线舌部分切除手术.方法对74例OSAHS患者和10例除外OSAHS的对照者,进行舌咽区上呼吸道CT扫描并进行舌动脉CT血管造影(computed tomography angiography,CTA)成像,除测量舌咽区呼吸道内径、截面积和舌体参数外,对舌动脉长度、舌根部各测量点的双侧舌动脉间距和舌动脉距舌表面深度进行测量,并比较两组患者各项测量参数的差异,对影响舌动脉走行的影响因素进行多元逐步回归分析.在舌动脉CTA成像和测量参数的指导下,对23例因为舌体肥厚造成舌后区呼吸道狭窄的OSAHS患者进行中线舌部分切除术.结果 OSAHS患者舌咽区呼吸道内径和截面积均明显小于对照组,舌体长度和舌体厚度均明显大于对照组(t检验,P值均<0.05或0.01).舌动脉长度和舌根部各测量点的双侧舌动脉间距差异无统计学意义.但OSAHS组舌根部各测量点舌动脉深度((-)x±s)分别为(29.1±5.5)mm、(26.9±5.1)mm和(25.6±5.2)mm,明显大于对照组的(23.0±3.8)mm、(22.6±2.7)mm和(21.5±2.6)mm,t检验P值均<0.05或0.01.多元逐步回归分析表明,影响舌动脉深度的主要因素分别为体重指数、舌长和舌厚,其偏回归系数分别为0.255,0.11和0.03,方差分析F=6.216,P<0.05.23例进行中线舌部分切除的患者手术切除范围和切除深度均明显超过既往文献所报告的舌中线旁7 mm、深10 mm的手术安全范围,未发生舌动脉和舌下神经损伤等并发症.结论 OSAHS患者舌动脉走行和测量参数与非OSAHS对照者存在差异,舌动脉CTA成像可以较好地反映舌动脉在舌体内的走行,在其指导下的中线舌部分切除术可以在保证手术安全的前提下扩大切除范围,以获得更好的疗效.
목적 비교조새성수면호흡잠정저통기종합정(OSAHS)환자여비OSAHS대조자설동맥주행규률급측량삼수적이동,지도중선설부분절제수술.방법 대74례OSAHS환자화10례제외OSAHS적대조자,진행설인구상호흡도CT소묘병진행설동맥CT혈관조영(computed tomography angiography,CTA)성상,제측량설인구호흡도내경、절면적화설체삼수외,대설동맥장도、설근부각측량점적쌍측설동맥간거화설동맥거설표면심도진행측량,병비교량조환자각항측량삼수적차이,대영향설동맥주행적영향인소진행다원축보회귀분석.재설동맥CTA성상화측량삼수적지도하,대23례인위설체비후조성설후구호흡도협착적OSAHS환자진행중선설부분절제술.결과 OSAHS환자설인구호흡도내경화절면적균명현소우대조조,설체장도화설체후도균명현대우대조조(t검험,P치균<0.05혹0.01).설동맥장도화설근부각측량점적쌍측설동맥간거차이무통계학의의.단OSAHS조설근부각측량점설동맥심도((-)x±s)분별위(29.1±5.5)mm、(26.9±5.1)mm화(25.6±5.2)mm,명현대우대조조적(23.0±3.8)mm、(22.6±2.7)mm화(21.5±2.6)mm,t검험P치균<0.05혹0.01.다원축보회귀분석표명,영향설동맥심도적주요인소분별위체중지수、설장화설후,기편회귀계수분별위0.255,0.11화0.03,방차분석F=6.216,P<0.05.23례진행중선설부분절제적환자수술절제범위화절제심도균명현초과기왕문헌소보고적설중선방7 mm、심10 mm적수술안전범위,미발생설동맥화설하신경손상등병발증.결론 OSAHS환자설동맥주행화측량삼수여비OSAHS대조자존재차이,설동맥CTA성상가이교호지반영설동맥재설체내적주행,재기지도하적중선설부분절제술가이재보증수술안전적전제하확대절제범위,이획득경호적료효.
Objective To explore the difference of lingual arterial CT angiography images (CTA) between obstructive sleep apnea hypopnea syndrome (OSAHS)patients and normal subjects, and to investigate the safety of partial glossectomy guided by lingual arteria CT angiography. Methods Seventy-four patients with OSAHS and 10 control adults were included in the study. The lingual upper airway and lingual arterial CT angiography were obtained. The area and the dimensions of lingual upper airway, and the length and thickness of lingua, length of lingual arteria, depth and bilateral lingual arteria spacing were studied. The CT measuring data of OSAHS patients and normal adults were compared. The muhinomial logistic regression analysis was used to investigate the main factors which affects the lingual arterial measuring results. Guided by the lingual arterial CT angiography and measuring results, glossectomy was performed in 23 OSAHS patients with lingua hypertrophy. Results The area and dimensions of lingual airway of OSAHS patients were less than those of control adults, and the length and thickness of lingua of OSAHS were more than those of control adults (t test, P<0.05 or P<0.01). There were no difference in length of lingual arteria and bilateral lingual arteria specing between OSAHS patients and control adults. The 3 measured points'depth ((-)x±s) of lingual arteria of OSAHS patients were (29.1±5.5) mm, (26.9± 5.1)mm and (25.6±5.2) mm, respectively, and those of control adult were (23.0±3.8) mm, (22.6± 2.7) mm and (21.5±2.6) mm, the depth of lingual arteria of OSAHS was more than that of control adults (t test, P<0.05 or P<0.01). The main factors affects lingual arterial depth were body mass index (BMI), Iingual length and lingual thickness, unstandardized regression coefficient were 0.255, 0.11 and 0.03,repectively (analysis of variance, F=6.216, P<0.05). No damage of lingual arteria and nerve in 23 patients who had expanded glossectomy. Conclusions The study showed statistical difference significance of lingual arterial CTA measurements between OSAHS patients and control adults. Guided with lingual arteria CTA data, the expanded glossectomy in OSAHS patients has proved good safety and high cure rate.