Research on failure reasons of surgical treatment of obstructive sleep apnea hypopnea syndrome and reoperation method
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摘要: 目的:分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)手术治疗后复发的原因,探讨再手术治疗的方案及疗效。方法:选择首次手术治疗后复发的OSAHS患者27例,行便携睡眠监测阻塞定位仪(AG)睡眠监测、电子鼻咽喉镜检查及Müller试验、鼻咽3D-CT。对其中入院再次接受手术治疗的14例患者针对不同阻塞平面,行改良UPPP、鼻腔扩容术、鼻咽部腺样体切除术、舌体部分切除术、气管切开术。术后半年AG睡眠监测、并发症观察,术前术后Epworth嗜睡量表评分。结果:术后半年AHI由(48.19±13.11)次/h降至(11.32±4.42)次/h,嗜睡量表评分由(12.93±4.60)分降至(4.93±1.44)分,均P<0.05。治愈2例,显效12例。术后无呼吸困难、出血、进食反流等并发症。结论:判定阻塞平面和选择适合的术式是提高疗效的关键,术前AG睡眠监测、鼻咽3D-CT、电子鼻咽喉镜检查对于判定阻塞平面、决定术式具有重要意义。
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关键词:
- 睡眠呼吸暂停低通气综合征,阻塞性 /
- 复发 /
- 悬雍垂腭咽成形术
Abstract: Objective: To analyze failure reasons of surgical treatment of obstructive sleep apnea hypopnea syndrome(OSAHS),and explore the methods of reoperation.Method: By selecting 27 patients, who accepted surgical treatment for OSAHS and recurred,we analyzed failure reasons and obstructive location by apneagraph, nasopharyngeal 3D-CT, electronic nasopharynlaryngoscope. Among them, 14 patients accepted reoperation,such as uvulopalatopharyngoplasty(UPPP),nasoendoscopic surgery, adenoidectomy,partial glossectomy, tracheotomy were applied matching to differential obstructive location. AHI,lowest SaO2,Epworth sleepiness scale (ESS),complication were recorded after 6 months.Result: After 6 months, their AHI decreased from 48.19±13.11 to 11.32±4.42,ESS scores decreased from 12.93±4.60 to 4.93±1.44,P<0.05.Two of the 14 patients were cured, while the other 12 were efficient. No complications were observed.Conclusion: Obstructive location judgement and proper surgical operation are the keys of the treatment. Preoperative AG sleep monitoring, nasopharyngeal 3D-CT, electronic nasopharynlaryngoscope examination for determining blocking plane, the decision of surgery which is significantl. -
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