【摘要】 目的探讨根据腭、舌部解剖结构应用低温等离子辅助行改良腭咽成形及舌根消融术治疗重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效并进行评价。方法对82例重度OSAHS患者用低温等离子辅助行改良腭咽成形(H-UPPP)及舌根消融术,术前行多导睡眠监测(PSG):AHI>50,LSaO2<80%;纤维喉镜配合Muller’s运动检查(FEMM)及MRI检查,患者均存在腭咽及舌根平面狭窄,术后6、12个月随访并行PSG监测等。结果术后6、12个月有效率分别为86.9%、80.2%,术后与术前比较AHI值下降(P<0.01),且LSaO2升高(P<0.05),所有患者主观症状较术前明显改善,有高血压等并发症的患者大部分减轻甚至恢复正常。6例患者术后5~9 d不同程度出血,少数患者1~2月内有味觉稍减退、咽干、返流、咽异物感,后均恢复正常,1例术后第10 d出现肺动脉栓塞,经治疗后好转;其余患者无并发症出现。结论根据腭、舌部解剖结构应用低温等离子辅助行改良腭咽成形及舌根消融术治疗重度OSAHS,作为一种微创手术,具有出血少、创伤小,并发症少的优点,是可行、安全而有效的,可成为OSAHS患者手术治疗的主要选择,值得在临床上推广。更多还原

【Abstract】 Objective By studying the anatomy of palate and tongue to investigate the therapeutic efficacy of Coblation-assisting Han-uvulopalatopharyngoplasty(H-UPPP)combining radiofrequency ablation of the tongue in patients with severe obstructive sleep apnea-hyponea syndrome(OSAHS). Methods 82 adult patients with severe OSAHS had the narrow path in the oropharynx and lingual root. All patients underwent the examinations of polysomnography(PSG), magnetic resonance image(MRI) and fibrolaryngoscopy combinged with Muller’s maneuver(FEMM). These patients were treated with H-UPPP combining radiofrequency ablation of the tongue to decrease the size of soft palate and the tongue. They were involved in the study and the apneahyponea index(AHI) was beyond 50/h and lowest arterial oxygen saturation(LSaO2) was under 80%. All patients were followed up for 6 to 12 months and underwent monitoring of PSG, electrocardiograph, blood pressure, blood sugar and blood fat. Results The Comparisonthe clinical data showed that 86.9% of the operated patients improved 6 months after the operation, 80.2% of the operated patients improves 12 months after the operation and the subjective symptoms of all patients were improved. AHI values were reduced significantly(P<0.01) and the lowest oxygen saturations increased significantly(P<0.05). Conclusions Profound knowledge of the anatomy of palate and tongue can facilate treatment of severe OSAHS by H-UPPP and combining radiofrequency ablation of the tongue, which is one of the safe and effective surgical methods.It is minimally invasive, resulting in less blood loss, less damage and less operative complications. It should be promoted prevalently.更多还原