[鼻手术联合改良悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停]

[Treating obstructive sleep apnea with nasal operation and revised uvulopalatopharyngoplasty].

作者信息

Hu Hai-Wen, Gan Zhong, Li Li-Hong, Liao Li-Bing, Gao Zeng-Bin

机构信息

Department of Otorhinolaryngology Centre, Guangdong Armed Police Hospital, Guangzhou 510507, China.

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2007 Feb;42(2):95-9.

PMID:17633249

Abstract

OBJECTIVE

Nasal operation and/or H-uvulopalatopharyngoplasty (UPPP) was performed for obstructive sleep apnea hypopnea syndrome (OSAHS) patients with both oral pharynx and nasal obstruction, results analyzed.

METHODS

Patients were divided into group A (46 cases) and group B (42 case) randomly. Nasal procedures were: septoplasty, radiofrequency reduction of inferior turbinate, adenoidectomy and functional endoscopic operation. Cases in group A had nasal operation first, while cases in group B first had UPPP. All patients had sleep study with polysomnography (PSG) 2 and 12 months after each operation. Those who failed to reach the criteria of being effective after first surgery (defined as a 25% reduction in baseline apnea hypopnea index (AHI) received second phase operation (nasal operation for group B and UPPP for group A). The response rates were compared between the two groups after each phase of operation.

RESULTS

In group A, the phase one operation were effective in 44.0% (11/25) for the mild degree OSAHS patients (defined as AHI < 20/h), according to the sleep study performed 2 months after surgery, and no recurrence after one-year. All moderate ones (defined as 20/h < AHI < 40/h) responded poorly to nasal operation. The overall response rate was 23.9% (11/46). Non-responses (35 cases) in group A underwent UPPP and the response rate to it was 85.7% (30/35) in one year. In group B, UPPP operation was effective in 63.6% (14/22) mild cases and 30.0% (6/20) moderate cases in 2 months but 4 cases had recurrence in one year. Twenty-two cases underwent the second phase operation of nose and the response rate was 86.4% (19/22) in one year. There was no statistical significance on the overall response rate between group A and B (89.1% vs 83.3%, P > 0.05). While there was statistical significance of response rate between those patients who had only one operation and those who had both surgeries (P < 0.05).

CONCLUSIONS

The combination of nasal procedures and UPPP is effective a for OSAHS patient with nasal diseases especially in mild and moderate cases.

摘要

目的

对患有口咽和鼻腔阻塞的阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者进行鼻腔手术和/或悬雍垂腭咽成形术（UPPP），并分析结果。

方法

将患者随机分为A组（46例）和B组（42例）。鼻腔手术包括：鼻中隔成形术、下鼻甲射频消融术、腺样体切除术和功能性鼻内镜手术。A组患者先进行鼻腔手术，而B组患者先进行UPPP。所有患者在每次手术后2个月和12个月进行多导睡眠图（PSG）睡眠监测。首次手术后未达到有效标准（定义为基线呼吸暂停低通气指数（AHI）降低25%）的患者接受第二阶段手术（B组进行鼻腔手术，A组进行UPPP）。比较两组在各阶段手术后的有效率。

结果

在A组中，根据术后2个月进行的睡眠监测，轻度OSAHS患者（定义为AHI<20/h）的第一阶段手术有效率为44.0%（11/25），一年后无复发。所有中度患者（定义为20/h<AHI<40/h）对鼻腔手术反应不佳。总体有效率为23.9%（11/46）。A组中无反应的患者（35例）接受了UPPP，一年后其有效率为85.7%（30/35）。在B组中，UPPP手术在2个月时对轻度病例的有效率为63.6%（14/22），对中度病例的有效率为30.0%（6/20），但一年后有4例复发。22例患者接受了第二阶段鼻腔手术，一年后有效率为86.4%（19/22）。A组和B组的总体有效率无统计学意义（89.1%对83.3%，P>0.05）。而仅接受一次手术的患者和接受两次手术的患者之间的有效率有统计学意义（P<0.05）。