[联合手术治疗重度阻塞性睡眠呼吸暂停低通气综合征的疗效]

[Effectiveness of combined surgery for treating severe obstructive sleep apnea hypopnea syndrome].

作者信息

Yi Hong-liang, Yin Shan-kai, Lu Wen-ying, Wu Hong-min, Guan Jian, Cao Zhen-yu, Chen Ting

机构信息

Department of Otorhinolaryngology, Affiliated Shanghai Sixth People's Hospital of Shanghai Jiao Tong University, China.

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2006 Feb;41(2):89-94.

PMID:16671516

Abstract

OBJECTIVE

To explore the efficiency of a comprehensive surgical approach of genioglossus advancement and hyoid suspension (GAHM) plus uvulopalatopharyngoplasty (UPPP) for treating severe obstructive sleep apnea hypopnea syndrome (OSAHS) and to evaluate related factors on surgery outcomes.

METHODS

Eighteen patients with severe OSAHS (apnea hypopnea index, AHI > 40/h) confirmed with polysomnography received genioglossus advancement and hyoid suspension plus uvulopalatopharyngoplasty. The obstruction in both the oropharynx and the hypopharynx were evaluated by preoperative physical examination, fiberoptic pharyngolaryngoscopy, cephalometry, and computed tomography of the upper airway. The follow up was at least 6 months postoperatively. The Wilcoxon signed rank test was used to compare the preoperative and postoperative results by SPSS 11.0 for windows. The Mann-Whitney test was used to analyze the difference between responders and nonresponders.

RESULTS

The follow up time ranges from 6 to 24 months, there were statistically significance in all but body mass index (BMI) between preoperative and postoperative measurements. Mean AHI was reduced from preoperative (x +/- s, 63.8 +/- 16.3)/h to postoperative (23.6 +/- 19.5)/h, lowest mean oxygen saturation increased from 0.72 +/- 0.07 to 0.81 +/- 0.13(x +/- s). According to criterion at home, the 6-month rate of responder is 83%, if AHI <20/h and decreased by at least 50% as success, the rate of success is 67%. The age, posterior airway space (PAS) and percentage of time with oxyhemoglobin saturation below 0.90 (CT90) were (39.1 +/- 7.4) years, (8.3 +/- 0.9) mm, (18.5 +/- 10.9)% in responder, while (52.5 +/- 9.4) years, (6.8 +/- 1.3) mm, (37.7 +/- 23.6) % in nonresponder, and there are statistically significant between responder and nonresponder.

CONCLUSIONS

GAHM plus UPPP is effective surgical approach for patients with severe OSAHS who suffer from oropharyngeal and hypopharyngeal obstruction. Age, PAS and CT90 were possible affective factors on surgical outcomes.

摘要

目的

探讨颏舌肌前移和舌骨悬吊术（GAHM）联合悬雍垂腭咽成形术（UPPP）治疗重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的疗效，并评估影响手术效果的相关因素。

方法

18例经多导睡眠图确诊的重度OSAHS患者（呼吸暂停低通气指数，AHI>40次/小时）接受颏舌肌前移和舌骨悬吊术联合悬雍垂腭咽成形术。术前通过体格检查、纤维喉镜、头影测量和上气道计算机断层扫描评估口咽和下咽的阻塞情况。术后随访至少6个月。采用Wilcoxon符号秩和检验，通过SPSS 11.0 for windows软件比较术前和术后结果。采用Mann-Whitney检验分析反应者和无反应者之间的差异。

结果

随访时间为6至24个月，除体重指数（BMI）外，术前和术后测量的所有指标均有统计学意义。平均AHI从术前的（x±s，63.8±16.3）次/小时降至术后的（23.6±19.5）次/小时，最低平均血氧饱和度从0.72±0.07升至0.81±0.13（x±s）。根据家庭标准，6个月时反应者的比例为83%，以AHI<20次/小时且降低至少50%为成功标准，成功率为67%。反应者的年龄、后气道间隙（PAS）和血氧饱和度低于0.90的时间百分比（CT90）分别为（39.1±7.4）岁、（8.3±0.9）mm、（18.5±10.9）%，无反应者分别为（52.5±9.4）岁、（6.8±1.3）mm、（37.7±23.6）%，反应者和无反应者之间有统计学意义。