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
2013年
4期
289-294
,共6页
董佳佳%叶京英%张俊波%曹鑫%檀俊龙
董佳佳%葉京英%張俊波%曹鑫%檀俊龍
동가가%협경영%장준파%조흠%단준룡
睡眠呼吸暂停,阻塞性%耳鼻喉外科手术%体层摄影术,X线计算机
睡眠呼吸暫停,阻塞性%耳鼻喉外科手術%體層攝影術,X線計算機
수면호흡잠정,조새성%이비후외과수술%체층섭영술,X선계산궤
Sleep apnea,obstructive%Otorhinolaryngologic surgical procedures%Tomography,X-ray computed
目的 研究改良悬雍垂腭咽成形术(H-uvulopalatopharyngoplasty,H-UPPP)与H-UPPP联合软腭前移术(transpalatal advancement pharyngoplasty,PA)治疗阻塞性睡眠呼吸暂停低通气综合征患者术后上气道结构的变化特点,比较两种术式对上呼吸道结构改变的差异,筛选与疗效相关的结构改变指标.方法 回顾性选取43例经单纯H-UPPP术(17例)或H-UPPP联合PA手术治疗(26例)的患者.手术前后行多道睡眠监测及平静呼气末上气道CT扫描和三维重建,测量上气道不同区域的径线、截面积与气道单位容积等指标.分别比较各组手术前后CT测量值的改变量,对比不同术式的两组患者结构改变量的差异.分析手术前后病情程度改变和结构指标改变量的相关性.结果 H-UPPP联合PA组和单纯H-UPPP组手术前后呼吸暂停低通气指数(AHI)降低值平均(x-±s,下同)分别为(67.5±l8.9)次/h和(38.7±42.0)次/h,硬腭长度减小值分别为(4.50±3.72) mm和(0.06±0.22)mm,硬腭水平前后径增加值分别为(3.5±4.3)mm和(-1.7±4.4)mm,腭咽区气道最小前后径增加值分别为(1.2±2.2)mm和(-1.2±2.3)mm,联合手术组改善更明显,差异均有统计学意义(t值分别为2.84、5.55、3.90、-3.49,P值＜0.05或＜0.01).单纯H-UPPP组舌咽区气道最小左右径增加值(13.1±9.1)mm较H-UPPP联合PA组(4.9±9.6)mm大(t=2.80,P＜0.01).术后较术前AHI降低百分比与手术前后硬腭长度减小值、硬腭水平气道前后径增加值、腭咽区气道最小前后径增加值及腭咽区气道最小截面积增加值呈正相关趋势(r值分别为0.407、0.351、0.381、0.312,P值＜0.05或＜0.01).结论 H-UPPP联合PA术较单纯行H-UPPP术对AHI的降低作用更明显,其机制可能是通过更有效扩大腭咽区气道的前后径实现的.腭咽区气道面积和径线的增加与手术疗效相关.
目的 研究改良懸雍垂腭嚥成形術(H-uvulopalatopharyngoplasty,H-UPPP)與H-UPPP聯閤軟腭前移術(transpalatal advancement pharyngoplasty,PA)治療阻塞性睡眠呼吸暫停低通氣綜閤徵患者術後上氣道結構的變化特點,比較兩種術式對上呼吸道結構改變的差異,篩選與療效相關的結構改變指標.方法 迴顧性選取43例經單純H-UPPP術(17例)或H-UPPP聯閤PA手術治療(26例)的患者.手術前後行多道睡眠鑑測及平靜呼氣末上氣道CT掃描和三維重建,測量上氣道不同區域的徑線、截麵積與氣道單位容積等指標.分彆比較各組手術前後CT測量值的改變量,對比不同術式的兩組患者結構改變量的差異.分析手術前後病情程度改變和結構指標改變量的相關性.結果 H-UPPP聯閤PA組和單純H-UPPP組手術前後呼吸暫停低通氣指數(AHI)降低值平均(x-±s,下同)分彆為(67.5±l8.9)次/h和(38.7±42.0)次/h,硬腭長度減小值分彆為(4.50±3.72) mm和(0.06±0.22)mm,硬腭水平前後徑增加值分彆為(3.5±4.3)mm和(-1.7±4.4)mm,腭嚥區氣道最小前後徑增加值分彆為(1.2±2.2)mm和(-1.2±2.3)mm,聯閤手術組改善更明顯,差異均有統計學意義(t值分彆為2.84、5.55、3.90、-3.49,P值＜0.05或＜0.01).單純H-UPPP組舌嚥區氣道最小左右徑增加值(13.1±9.1)mm較H-UPPP聯閤PA組(4.9±9.6)mm大(t=2.80,P＜0.01).術後較術前AHI降低百分比與手術前後硬腭長度減小值、硬腭水平氣道前後徑增加值、腭嚥區氣道最小前後徑增加值及腭嚥區氣道最小截麵積增加值呈正相關趨勢(r值分彆為0.407、0.351、0.381、0.312,P值＜0.05或＜0.01).結論 H-UPPP聯閤PA術較單純行H-UPPP術對AHI的降低作用更明顯,其機製可能是通過更有效擴大腭嚥區氣道的前後徑實現的.腭嚥區氣道麵積和徑線的增加與手術療效相關.
목적 연구개량현옹수악인성형술(H-uvulopalatopharyngoplasty,H-UPPP)여H-UPPP연합연악전이술(transpalatal advancement pharyngoplasty,PA)치료조새성수면호흡잠정저통기종합정환자술후상기도결구적변화특점,비교량충술식대상호흡도결구개변적차이,사선여료효상관적결구개변지표.방법 회고성선취43례경단순H-UPPP술(17례)혹H-UPPP연합PA수술치료(26례)적환자.수술전후행다도수면감측급평정호기말상기도CT소묘화삼유중건,측량상기도불동구역적경선、절면적여기도단위용적등지표.분별비교각조수술전후CT측량치적개변량,대비불동술식적량조환자결구개변량적차이.분석수술전후병정정도개변화결구지표개변량적상관성.결과 H-UPPP연합PA조화단순H-UPPP조수술전후호흡잠정저통기지수(AHI)강저치평균(x-±s,하동)분별위(67.5±l8.9)차/h화(38.7±42.0)차/h,경악장도감소치분별위(4.50±3.72) mm화(0.06±0.22)mm,경악수평전후경증가치분별위(3.5±4.3)mm화(-1.7±4.4)mm,악인구기도최소전후경증가치분별위(1.2±2.2)mm화(-1.2±2.3)mm,연합수술조개선경명현,차이균유통계학의의(t치분별위2.84、5.55、3.90、-3.49,P치＜0.05혹＜0.01).단순H-UPPP조설인구기도최소좌우경증가치(13.1±9.1)mm교H-UPPP연합PA조(4.9±9.6)mm대(t=2.80,P＜0.01).술후교술전AHI강저백분비여수술전후경악장도감소치、경악수평기도전후경증가치、악인구기도최소전후경증가치급악인구기도최소절면적증가치정정상관추세(r치분별위0.407、0.351、0.381、0.312,P치＜0.05혹＜0.01).결론 H-UPPP연합PA술교단순행H-UPPP술대AHI적강저작용경명현,기궤제가능시통과경유효확대악인구기도적전후경실현적.악인구기도면적화경선적증가여수술료효상관.
Objective To compare the different postoperative changes of the pharynx in obstructive sleep apnea hypopnea syndrome (OSAHS) patients treated with H-uvulopalatopharyngoplasty (H-UPPP) combined with transpalatal advancement pharyngoplasty (PA) surgery or H-UPPP alone.Methods The upper airway in 43 patients with OSAHS were scanned during the end of normal respiration before and after treatment.There were 17 patients undergoing H-UPPP alone,26 patients undergoing H-UPPP combined with PA,with PSG before and after treatment.To compare the efficacy of H-UPPP with PA surgery or H-UPPP alone,upper airway characteristics were measured following each procedure in 43 patients using a quantitative 3-D CT.The 3-D CT measurement were made in lateral and anterior-posterior diameters,crosssection areas and volumes of retropalatal and retroglossal region.The changes in the structure of OSAHS patients treated with H-UPPP combined with PA surgery and H-UPPP alone were compared preoperatively and postoperatively,and the correction features that were presented in AHI and structural changes were analysed.Results The difference between H-UPPP combined with PA (n =26) and H-UPPP (n =17) in the changes in apnea hypopnea index (AHI) were (67.5 ± 18.9,38.7 ± 42.0,t =2.84,P ＜ 0.05),hard palate lengths were (4.50 ± 3.72) mm and (0.06 ± 0.22) mm (t =5.55,P ＜ 0.01) ; anteroposterior diameters of the hard palate level were (3.5 ± 4.3) mm and (-1.7 ± 4.4) mm(t =3.90,P ＜ 0.01) ; the minimum anteroposterior diameters of retropalatal were (1.2 ± 2.2) mm and (-1.2 ± 2.3) mm (t =-3.49,P ＜ 0.01) ; the minimum lateral diameters of retroglossal area were (4.9 ± 9.6) mm and (13.1 ±9.1)mm (t =2.80,P ＜ 0.01) preoperatively and postoperatively.The changes in the hard palate lengths were positively correlated to the change in AHI (r =0.407,P ＜ 0.01),also the change in anteroposterior diameter of the hard palate level (r =0.351,P ＜ 0.05),the minimum anteroposterior diameter of retropalatal area (r =0.381,P ＜ 0.01),and the minimum cross-section area of retropalatal (r =0.312,P ＜0.05).Conclusions H-UPPP combined with PA offers benefit over H-UPPP alone in OSAHS patients,which may be achieved by increased retropalatal airway size.Both the anteroposterior dimensions and the cross-area size are related with the efficacy of surgery.
