CAJ | 학술논문

目的探讨改良悬雍垂腭咽成形术(H-UPPP)联合软腭前移术(PA)对阻塞型睡眠呼吸暂停低通气综合征患者术后上气道结构变化的影响.方法选取86例阻塞型睡眠呼吸暂停低通气综合征患者,分别行单纯H-UPPP(对照组,39例)或H-UPPP联合PA(观察组,47例)治疗.比较两组手术前后上气道结构指标CT测量值和呼吸暂停低通气指数(AHI)的变化.结果观察组手术有效率为80.9％(38/47),显著高于对照组的56.4％(22/39),差异有统计学意义(P＜0.05).观察组和对照组手术前后AHI降低值分别为(40.5±14.6)次/h和(16.7±12.0)次/h,硬腭长度减小值分别为(5.5±3.2)mm和(1.6±0.2)mm,硬腭前后径增加值分别为(3.6±2.3)mm和(-1.6±3.4)mm,腭咽前后径增加值分别为(1.6±1.2) mm和(-1.2±1.8)mm,观察组改善情况明显优于对照组,差异均有统计学意义(P＜0.05).对照组舌咽区气道最小左右径增加值为(13.2±3.1)mm,显著大于观察组的(4.9±1.6)mm,差异有统计学意义(P＜0.05).结论 H-UPPP联合PA较单纯行H-UPPP对阻塞型睡眠呼吸暂停低通气综合征患者疗效显著,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.
목적 탐토개량현옹수악인성형술(H-UPPP)연합연악전이술(PA)대조새형수면호흡잠정저통기종합정환자술후상기도결구변화적영향.방법 선취86례조새형수면호흡잠정저통기종합정환자,분별행단순H-UPPP(대조조,39례)혹H-UPPP연합PA(관찰조,47례)치료.비교량조수술전후상기도결구지표CT측량치화호흡잠정저통기지수(AHI)적변화.결과 관찰조수술유효솔위80.9％(38/47),현저고우대조조적56.4％(22/39),차이유통계학의의(P＜0.05).관찰조화대조조수술전후AHI강저치분별위(40.5±14.6)차/h화(16.7±12.0)차/h,경악장도감소치분별위(5.5±3.2)mm화(1.6±0.2)mm,경악전후경증가치분별위(3.6±2.3)mm화(-1.6±3.4)mm,악인전후경증가치분별위(1.6±1.2) mm화(-1.2±1.8)mm,관찰조개선정황명현우우대조조,차이균유통계학의의(P＜0.05).대조조설인구기도최소좌우경증가치위(13.2±3.1)mm,현저대우관찰조적(4.9±1.6)mm,차이유통계학의의(P＜0.05).결론 H-UPPP연합PA교단순행H-UPPP대조새형수면호흡잠정저통기종합정환자료효현저,대AHI적강저작용경명현,기궤제가능시통과경유효확대악인구기도적전후경실현적.
Objective To compare the upper airway changes after H-uvulopalatopharyngoplasty (H-UPPP) combined with transpalatal advancement pharyngoplasty (PA) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods Eighty-six patients with OSAHS were selected,39 patients were treated with H-UPPP alone (control group),and 47 patients were treated with H-UPPP combined with PA (observation group).The upper airway changes were measured by CT and apnea hypopnea index (AHI) change in the 2 groups were compared before and after operation.Results The surgery effective rate in observation group was 80.9％ (38/47),in control group was 56.4％ (22/39),there was statistical difference (P ＜ 0.05).The AHI depressed value before and after operation in observation group and control group were (40.5 ± 14.6) times/h and (16.7 ± 12.0) times/h respectively,the hard palate length depressed value were (5.5 ± 3.2) mm and (1.6 ± 0.2) mm respectively,the anteroposterior diameter incremental value of hard palate were (3.6 ± 2.3) mm and (-1.6 ± 3.4) mm respectively,the anteroposterior diameter incremental value of palate and pharynx were (1.6 ± 1.2) mm and (-1.2 ± 1.8) mm respectively,the above indexes in observation group were significantly better than those in control group,there were statistical differences (P ＜ 0.05).The minimum diameter incremental value of retropalatal airway in control group was (13.2 ± 3.1) mm,in observation group was (4.9 ± 1.6) mm,there was statistical difference (P ＜ 0.05).Conclusion H-UPPP combined with PA offers benefit over H-UPPP alone in patients with OSAHS,which may be achieved by increasing anteroposterior diameter of palate and pharynx.