【摘要】 目的:总结重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)鼻、口咽、喉咽多平面阻塞术前相关检查方法、围手术期处理、手术方式的选择及术后的处理,探讨提高OSAHS疗效、减少复发及预防和降低手术风险的经验。方法:自2012年4月-2013年12月对35例重度OSAHS患者,通过临床常规检查、纤维鼻咽喉镜、X-线投影测量、CBCT气道重建和Alice5多导睡眠监测仪监测(PSG)。在完善围手术期处理后全麻一期完成鼻腔扩容手术、腭垂腭咽成形术(Uvulopalatopharyngoplasty,UPPP)、腭扁桃体切除手术;颏部"开窗""凸"形或"梯形"截骨前徙颏部及颏舌肌和舌骨上肌群的颏前徙术;舌骨下肌群切断、舌骨悬吊术。术后气管插管维持24~48 h。结果:经过8~20个月随访,35例手术创口均一期愈合,根据疗效评定标准评定,治愈21例,显效10例,有效4例,无效0例,总有效率100%。睡眠呼吸暂停低通气指数(AHI)由术前(59.53±7.74)次/h下降为术后(13.65±4.76)次/h,Sa O2由术前(41.97±9.11)%上升为(90.40±4.83)%,最长睡眠呼吸暂停时间由术前(63.14±6.85)s下降为(23.54±6.80)s。结论:存在上气道结构性狭窄的重度OSAHS完善术前检查及围手术期处理,采取同期多平面手术治疗,可明显提高治疗效果且缩短疗程及降低手术风险,经治病例均获得满意疗效。更多还原

【Abstract】 Objective:To explore the preoperative examination,perioperative treatment,operation treatment,postoperative treatment of multi-level surgery on severe obstructive sleep apnea hypopnea syndrome(OSAHS) though nose,oropharyngeal,laryngeal pharynx,to improve curative effect,reduce the recurrence,prevent and reduce the operation risk of surgery.Method:35 cases who encounter severe obstructive sleep apnea hypopnea syndrome during April 2012 to December 2013 received expansion of the nasal cavity operation,uvulopalatopharyngoplasty,palatine tonsil resection operation,chin "window" "convex" shape or "trapezoid" osteotomy advancementgenioplasty and genioglossus and hyoid bone muscleadvancement genioplasty,infrahyoid cut,hyoid suspension, maintain tracheal intubation 24-48 h after operation. Result:After 8-20 months of follow up, in 35 cases, all the operations were performed successfully. 21 cases cured, 10 cases markedly effective,4 cases effective, the total efficiency was 100%.There were no sleep arousal phenomenon.Mean AHI decreased from(59.53±7.74)time/h preoperative to postoperative(13.65±4.76)time/h,lowest mean oxygen saturation increased from(41.97±9.11)% to(90.40±4.83)% the longest apnea time decreased from(63.14±6.85)s to(23.54±6.80)s.The cases with genioplasty were satisfied with the appearance was improved.Conclusion:The one stage multi-level surgery improve curative effect, reduce the recurrence and the operation risk for the treatment of severe OSAHS.更多还原