阻塞性睡眠呼吸暂停低通气综合征患者改良悬雍垂腭咽成形术术后上气道重塑规律研究

崔前波; 谭健; 邹哲飞; 陈伟

doi:10.13201/j.issn.2096-7993.2022.07.003

阻塞性睡眠呼吸暂停低通气综合征患者改良悬雍垂腭咽成形术术后上气道重塑规律研究

- 1.
  华中科技大学同济医学院附属武汉中心医院耳鼻咽喉科(武汉，430014)
- 2.
  华中科技大学同济医学院附属武汉中心医院分子诊断湖北省重点实验室
基金项目:
武汉市卫健委基金项目(No：WX14C11)

详细信息

通讯作者: 陈伟，E-mail：cw99990@163.com

中图分类号: R766

收稿日期: 2022-03-09

刊出日期: 2022-07-03

Morphological changes of upper airway in patients with obstructive sleep apnea hypopnea syndrome after H-UPPP

- 1.
  Department of Otorhinolaryngology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
- 2.
  Key Laboratory for Molecular Diagnosis of Hubei Province, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology

More Information

Corresponding author: CHEN Wei, E-mail: cw99990@163.com

Received Date: 09 March 2022

Publish Date: 03 July 2022

摘要

摘要: 目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者行改良悬雍垂腭咽成形术(H-UPPP)后上气道腭咽平面的形态变化规律及与疗效的相关性。方法选取2016年1月—2019年9月在武汉中心医院行H-UPPP的中重度OSAHS患者36例，于术前和术后1个月、3个月、6个月、1年、2年时测算BMI值，并行PSG检测AHI、LSaO₂、CT90，采用64排螺旋CT检查腭咽平面最小前后径、左右径和截面积的变化情况。结果 AHI、LSaO₂、CT90、BMI及腭咽平面最小前后径、左右径、截面积的变化在术后1个月时最明显。其中左右径的扩大可维持至术后6个月，术后1年逐渐回缩; 前后径的改善则可维持至术后3个月，术后2年时恢复到术前水平; 最小截面积在术后1个月时扩大明显，3个月后即出现缩小趋势，但术后2年观察时仍较术前有明显改善(P < 0.05);AHI的变化与最小截面积类似，术后2年仍有显著差异(P < 0.001);LSaO₂的改善在术后1个月时最明显，可维持至术后3个月，后逐渐恢复; CT90的改善可维持至术后半年，在术后1年时下降明显; BMI在术后1年仍好于术前，但术后2年时恢复至术前水平。AHI与腭咽平面最小前后径和截面积的变化显著相关，而与左右径无明显相关。结论 OSAHS患者H-UPPP术后上气道形态变化主要为前后径、左右径、最小截面积扩大，以术后3个月最为明显，3个月后逐渐出现前后径和最小截面积变小; 最小前后径和截面积的变化可反映手术疗效。
- 睡眠呼吸暂停低通气综合征，阻塞性 /
- 悬雍垂腭咽成形术 /
- 体层摄影术
Abstract: Objective 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.Methods 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.Results 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(P < 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(P < 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.Conclusion 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.
- sleep apnea hypopnea syndrome, obstructive /
- uvulopalatopharyngoplasty /
- tomograhy

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图 1 H-UPPP术前及术后腭咽平面最小左右径(1a)、前后径(1b)、截面积(1c)及AHI(1d)、LSaO₂(1e)、BMI(1f)、CT90(1g)的变化

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表 1 36例患者术后各时间节点疗效比较例(%)

时间	治愈	显效	有效	总有效
术后1个月	1(2.8)	12(33.3)	1(2.8)	14(38.9)
术后3个月	2(5.6)	10(27.8)	2(5.6)	14(38.9)
术后6个月	1(2.8)	12(33.3)	0(0)	13(36.1)
术后1年	0(0)	5(13.9)	1(2.8)	6(16.7)
术后2年	0(0)	4(11.1)	2(5.6)	6(16.7)

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