Cai Xiao-Lan, Liu Hong-Ying, Liu Yan-Xun, Sun Fu-Sheng, Wang Ting-chu
Otorhinolaryngology Institute of Health Ministry, Shandong University, Jinan 250012, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2005 Apr;40(4):247-52.
To evaluate the indications of uvulopalatopharyngoplasty (UPPP) and clinical staging for oropharyngeal narrow in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).
Sixty-six OSAHS patients were retrospectively analyzed, the data of physical examination and clinical staging for oropharyngeal narrow were built based on body mass index (BMI), palate-tongue position, tonsil sizes and hypertrophy degree in lateral side of oropharynx. The patients who had palatine-tongue position in degree 1 to 2 (no significant tongue enlargement) were defined as stage I (32 cases). The patients who had palatine-tongue position in degree 3 to 4 (tongue enlargement) were defined as stage II (34 cases). Among them, the patients with tonsil sizes 0 to 1 were stage I a (5 cases) and stage IIa (10 cases), another group with tonsil size 2 to 4 were stage I b (27 cases) and stage II b (24 cases), respectively. The indications of UPPP were evaluated according to the results of polysomnography (PSG) before and after operation.
PSG in 1 to 2 years after operation showed: the surgical efficiency of UPPP had not any difference (P > 0.05) among different groups with the severity of OSAHS(labeled in preoperational AHI and LSaO2). Surgical results was better in patients with BMI < 30 kg/m2 (P = 0.023). Success of operation was defined as postoperational AHI <20/h and reduced more than 50% compared to preoperational AHI and symptoms alleviated significantly. Successful rates of UPPP in stage I b (70.4%, 19/27 cases) were statistically higher than that of other groups (I a:0%; I b:70. 4%; II a:20.0%; II b: 16.7%).
Clinical staging system for oropharyngeal narrow is based on palate-tongue position and tonsil size. It is helpful to choose the surgical indications of UPPP for patients with OSAHS. It is the best UPPP indication for stage I b patients who had no tongue enlargement (palatine-tongue position 1 to 2) and accompanied with enlargement of tonsil size (in degree 2 to 4) and their sleep breathing disorder could be alleviated through UPPP.
评估悬雍垂腭咽成形术（UPPP）的适应证及阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者口咽狭窄的临床分期。
回顾性分析66例OSAHS患者，根据体重指数（BMI）、腭舌位置、扁桃体大小及口咽侧壁肥大程度建立体格检查和口咽狭窄临床分期数据。腭舌位置为1至2度（无明显舌体增大）的患者定义为I期（32例）。腭舌位置为3至4度（舌体增大）的患者定义为II期（34例）。其中，扁桃体大小为0至1度的患者为I a期（5例）和II a期（10例），另一组扁桃体大小为2至4度的患者分别为I b期（27例）和II b期（24例）。根据手术前后多导睡眠图（PSG）结果评估UPPP的适应证。
术后1至2年的PSG显示：UPPP的手术效果在不同OSAHS严重程度组（以术前呼吸暂停低通气指数（AHI）和最低血氧饱和度（LSaO2）标记）之间无差异（P>0.05）。BMI<30kg/m2的患者手术效果更好（P = 0.023）。手术成功定义为术后AHI<20次/小时，较术前AHI降低超过一半且症状明显缓解。I b期UPPP的成功率（70.4%，19/27例）在统计学上高于其他组（I a期：0%；I b期：70.4%；II a期：20.0%；II b期：16.7%）。
口咽狭窄的临床分期系统基于腭舌位置和扁桃体大小。有助于为OSAHS患者选择UPPP的手术适应证。对于无舌体增大（腭舌位置1至2度）且伴有扁桃体大小增大（2至4度）且睡眠呼吸障碍可通过UPPP缓解的I b期患者，是UPPP的最佳适应证。
