Study on the structural changes of pharyngeal cavity after bariatric surgery in obese patients with obstructive sleep apnea
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摘要: 目的 研究减重手术是否以及如何改变肥胖合并阻塞性睡眠呼吸暂停(OSA)患者的咽腔结构。方法 招募42例行腹腔镜下袖状胃切除术的患者, 在术前以及术后3、6、12个月评估形态学指标(BMI、颈围和腰围)、PSG指标和咽声反射指标。结果 包括形态学、咽腔结构和OSA严重程度在内的所有指标在手术后均发生了显著变化, 其中, BMI、颈围、腰围和AHI值显著降低(P < 0.001), 而咽腔容积、咽体积、口咽结合处面积、声门面积和LSaO2显著增加(P < 0.001)。多重比较结果显示, BMI、颈围和腰围在6个月前显著下降, 6~12个月时变化不显著; AHI和LSaO2的降低主要发生在0~3个月, 3个月与6个月、6个月与12个月之间差异无统计学意义; 术后口咽结合处面积在0~3个月内显著增加, 而咽腔容积和声门区面积在术后6、12个月显著增加。结论 减重手术可以显著降低体重, 减少颈部脂肪堆积; 扩大咽腔容积和横截面积, 改善上气道阻塞情况, 可以在一定程度上减轻肥胖合并OSA患者的睡眠呼吸暂停症状。
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关键词:
- 减重手术 /
- 睡眠呼吸暂停, 阻塞性 /
- 咽声反射 /
- 口咽
Abstract: Objective To study whether and how bariatric surgery changes the structure of the pharyngeal cavity in obese patients with obstructive sleep apnea (OSA).Methods Forty-two patients who underwent laparoscopic sleeve gastrectomy were recruited.Morphological indicators (BMI, neck and waist circumference), PSG and acoustic pharyngometry indicators were evaluated pre-operatively and 3, 6, and 12 months post-operatively.Results All indicators including morphology, pharyngeal cavity structure and OSA severity changed significantly after surgery.Among them, BMI, neck circumference, waist circumference and AHI value were significantly reduced (P < 0.001), while pharyngeal cavity volume, pharynx volume, oropharyngeal junction area, glottis area and LSaO2 increased significantly (P < 0.001).The results of multiple comparisons showed that BMI, neck and waist circumference decreased significantly in the first 6 months, and no further decline occurred during 6 to 12 months postoperatively.The decrease in AHI and LSaO2 mainly occurred within the first 3 months postoperatively, while there was no statistically significant difference in these two indicatiors between 3 months vs.6 months, 6 months vs.12 months postoperatively.The area of the oropharyngeal junction increased significantly within 0 to 3 months after surgery, while the volume of the pharyngeal cavity and the area of the glottis increased at 6 months and 12 months after surgery.Conclusion Bariatric surgery can significantly reduce body weight and reduce fat accumulation in the neck.It can also enlarge the volume and cross-sectional area of the pharyngeal cavity, and improve upper airway obstruction, therefore reduce the symptoms of sleep apnea in obese patients with OSA to a certain extent.-
Key words:
- bariatric surgery /
- sleep apnea, obstructive /
- acoustic pharyngometry /
- oropharynx
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表 1 术前及术后3、6、12个月各项指标之间的多重比较结果
x±s 指标 术前 3个月 6个月 12个月 F P 形态学指标 BMI 39.35±7.50 33.99±7.361) 30.83±6.621)2) 29.71±5.081)2) 17.39 < 0.01 颈围/cm 43.37±4.35 40.01±3.771) 38.32±3.491) 36.93±4.051)2) 20.96 < 0.01 腰围/cm 119.54±13.55 110.57±13.911) 104.55±12.821)2) 102.86±10.931)2) 14.43 < 0.01 PSG指标 AHIa) 28.45±23.58 14.56±13.271) 11.15±9.551) 8.40±7.961) 15.01 < 0.01 LSaO2 a) 0.76±0.14 0.85±0.091) 0.90±0.071) 0.91±0.111)2) 20.76 < 0.01 咽声反射指标 咽腔容积a)/mL 23.02±4.78 26.17±4.251) 28.40±3.921) 29.17±3.171)2) 19.26 < 0.01 口咽结合处面积/cm2 0.91±0.32 1.04±0.251) 1.11±0.321) 1.15±0.271) 5.40 0.01 声门区面积a)/cm2 0.98±0.30 1.14±0.26 1.24±0.221) 1.24±0.191) 10.16 < 0.01 与术前比较，1)P < 0.01；与术后3个月比较，2)P < 0.01。
注：a)方差不齐，采用Welch检验结果。
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