[阻塞性睡眠呼吸暂停低通气综合征患者行悬雍垂腭咽成形术后上气道的形态学变化]
[Morphological changes of upper airway in patients with obstructive sleep apnea hypopnea syndrome after H-UPPP].
作者信息
Cui Qianbo, Tan Jian, Zou Zhefei, Chen Wei
机构信息
Department of Otorhinolaryngology，the Central Hospital of Wuhan，Tongji Medical College，Huazhong University of Science and Technology，Wuhan，430014，China.
Key Laboratory for Molecular Diagnosis of Hubei Province，the Central Hospital of Wuhan，Tongji Medical College，Huazhong University of Science and Technology.
出版信息
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Jul;36(7):497-500. doi: 10.13201/j.issn.2096-7993.2022.07.003.
To investigate the morphological changes of the upper airway palatepharyngeal plane after modified uvulopalatopharyngoplasty（H-UPPP） in patients with obstructive sleep apnea hypopnea syndrome（OSAHS） and efficacy of the surgery. Thirty-six patients diagnosed as moderate to severe OSAHS in the Central Hospital of Wuhan from January 2016 to September 2019 were treated with H-UPPP. PSG and 64 slice spiral CT were performed before operation, 1 month, 3 months, 6 months, 1 year and 2 years after operation to evaluate the changes of AHI, LSaO₂, CT90, BMI and the minimum anterior and posterior axis diameter, left and right axis diameter and cross-sectional volume of velopharyngeal plane, respectively. The AHI, LSaO₂, CT90, BMI were significantly improved, while the minimum anterior posterior axis diameter, left and right axis diameter and cross-sectional volume of velopharyngeal plane were enlarged in the maximum extent at one month after operation. The alteration of left and right axis diameter could be maintained until half a year after operation, but gradually retracted after 1 year after operation. The improvement of anterior and posterior axis diameter can only be maintained until 3 months after operation, and return to the preoperative level 2 years after operation; The minimum cross-sectional area improved significantly at 1 month after operation and decreased after 3 months, but there was still a significant improvement at 2 years after operation（<0.05）. The change of AHI was similar to that of the minimum cross-sectional area, and there was still a significant difference at 2 years after operation（<0.001）; The improvement of LSaO₂ was the most significant at 1 month after operation, which could be maintained until 3 months after operation, and then gradually recovered. The improvement of CT90 could be maintained until half a year after operation, and decreased significantly at 1 year after operation. BMI was still better than that before operation at 1 year after operation, but returned to the preoperative level at 2 years after operation. The improvement of AHI was mainly related to the minimum anterior posterior axis diameter and cross-sectional area of velopharyngeal plane, but not to the left and right axis diameters. The morphological changes of upper airway in patients with OSAHS after H-UPPP are mainly the improvement of anterior posterior diameter, left and right diameter and minimum cross-sectional area caused by removing the anatomical load of upper airway within 3 months after operation, but the reduction of anterior posterior diameter and minimum cross-sectional area gradually occurs after 3 months, resulting in the weakening of surgical effect.
探讨改良悬雍垂腭咽成形术（H-UPPP）治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者后上气道腭咽平面的形态学变化及手术疗效。选取2016年1月至2019年9月在武汉市中心医院确诊为中重度OSAHS的36例患者行H-UPPP治疗。分别于术前、术后1个月、3个月、6个月、1年及2年行多导睡眠监测（PSG）及64排螺旋CT检查，评估睡眠呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSaO₂）、阻塞性睡眠呼吸暂停低通气指数（CT90）、体重指数（BMI）以及腭咽平面最小前后径、左右径和截面积的变化。术后1个月时AHI、LSaO₂、CT90、BMI显著改善，腭咽平面最小前后径、左右径和截面积增大至最大程度。左右径的改变可持续至术后半年，但术后1年逐渐回缩。前后径的改善仅能维持至术后3个月，术后2年恢复至术前水平；最小截面积术后1个月显著改善，3个月后减小，但术后2年仍有显著改善（<0.05）。AHI的变化与最小截面积相似，术后2年仍有显著差异（<0.001）；LSaO₂术后1个月改善最显著，可维持至术后3个月，随后逐渐恢复。CT90的改善可维持至术后半年，术后1年显著下降。BMI术后1年仍优于术前，但术后2年恢复至术前水平。AHI的改善主要与腭咽平面最小前后径和截面积有关，与左右径无关。OSAHS患者H-UPPP术后上气道形态学变化主要是术后3个月内通过解除上气道解剖负荷使前后径、左右径及最小截面积增大，但3个月后前后径及最小截面积逐渐减小，导致手术效果减弱。
Zotero 插件