咽侧壁分层缝合联合软腭低温等离子消融治疗重度阻塞性睡眠呼吸暂停低通气综合征患者的疗效

doi:10.13481/j.1671-587x.20170332

吉林大学学报(医学版) ›› 2017, Vol. 43 ›› Issue (03): 630-634.doi: 10.13481/j.1671-587x.20170332

咽侧壁分层缝合联合软腭低温等离子消融治疗重度阻塞性睡眠呼吸暂停低通气综合征患者的疗效

王伟倩¹, 李佳², 王曦², 冯勇², 卢雅艳², 赵娟², 徐金操²

1. 锦州医科大学附属火箭军总医院研究生培养基地, 北京 100088;
2. 中国人民解放军火箭军总医院耳鼻咽喉-头颈外科, 北京 100088

收稿日期:2016-08-22 出版日期:2017-05-28 发布日期:2017-06-01
通讯作者: 徐金操,副主任医师,硕士研究生导师(Tel:010-66343357,E-mail:xujincao@126.com) E-mail:xujincao@126.com
作者简介:王伟倩(1989-),女,山东省烟台市人,在读医学硕士,主要从事呼吸系统疾病的微创外科治疗方面的研究。
基金资助:
中国人民解放军总后勤部卫生局全军"十二五"技术课题面上项目资助课题（CWS11J034）；中国人民解放军总后勤部卫生局全军保健专项资助课题（15BJZ23）

Curative effect of stratified suture of lateral pharyngeal wall combined with soft palate radiofrequency coblation in treatment of patients with severe obstructive sleep apnea hypopnea syndrome

WANG Weiqian¹, LI Jia², WANG Xi², FENG Yong², LU Yayan², ZHAO Juan², XU Jincao²

1. Trainning Base of Postgraduates, Affiliated General Hospital, PLA Rocket Force, Jinzhou Medical University, Beijing 100088, China;
2. Department of Otolaryngology and Head-Neck Surgery, General Hospital, PLA Rocket Force, Beijing 100088, China

Received:2016-08-22 Online:2017-05-28 Published:2017-06-01

摘要/Abstract

摘要： 目的：探索咽侧壁分层缝合（SSLPW）联合软腭低温等离子消融治疗重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的可行性和临床效果。方法：收集行咽侧壁成形术（LP）联合软腭低温等离子消融术治疗的21例重度OSAHS患者（LP组）和行SSLPW联合软腭低温等离子消融术治疗的39例重度OSAHS患者（SSLPW组）的临床资料，回顾性分析2组患者术前和术后呼吸暂停低通气指数（AHI）、最低动脉血氧饱和度（LSaO₂）、Epworth嗜睡量表（ESS）评分及术后相关并发症发生情况，并比较2组患者的手术成功率。结果：LP组患者治愈1例（5%），显效19例（90%），有效1例（5%），无效0例，手术成功率为95.2%（20/21）；SSLPW组患者治愈2例（5.1%），显效33例（84.6%），有效4例（10.3%），无效0例，手术成功率为89.7%（35/39）；2组患者手术成功率比较差异无统计学意义（P>0.05）。2组患者主观症状均明显改善，术后1个月随访未出现鼻咽部反流及吞咽困难。与术前比较，2组患者术后AHI和ESS评分降低（P<0.05），LSaO₂升高（P<0.05）。结论：SSLPW联合软腭低温等离子消融术后患者AHI、LSaO₂及ESS评分均改善明显，其可以作为治疗重度OSAHS患者的良好手段。

关键词: 咽侧壁分层缝合, 射频消融术, 阻塞性睡眠呼吸暂停低通气综合征, 软腭

Abstract: Objective: To explore the feasibility and clinical efficacy of stratified suture of lateral pharyngeal wall(SSLPW) combined with soft palate radiofrequency coblation in the treatment of the patients with severe obstructive sleep apnea hypopnea syndrome(OSAHS). Methods: The clinical data of 21 severe OSAHS patients underwent lateral pharyngoplasty(LP) combined with soft palate radiofrequency coblation (LP group) and 39 severe OSAHS patients underwent SSLPW combined with soft palate radiofrequency coblation (SSLPW group) were selected.The apnea hypopnea index(AHI),lowest SaO₂(LSaO₂),Epworth sleepiness scale(ESS) scores,and related postoperative complications of the patients in two groups were analyzed before and after operation.The successful rates of operation of the patients in two were compared. Results: In LP group, 1 patient was cured (5%), 19 patients were improved markedly (90%), 1 patient was effective (5%), and no patient was invalid; the successful rate was 95.2%(20/21).In SSLPW group, 2 patients were cured (5.1%), 33 patients were improved markedly (84.6%), 4 patients were effective (10.3%), and no patients was invalid; the successful rate was 89.7%(35/39); there was no statistical difference in the successful rate of operation of the patients between two groups (P>0.05). There was statistically significant improvementof the subjective symptoms. Allthe patients returned to normal subjective swallowing functions without nasal pharyngeal reflux and dysphagia in one month follow-up after operation.Compared with before operation,the AHI and ESS scores of the patients in two groups after operation were decreased(P<0.05);the LSaO₂ scores were increased(P<0.05). Conclusion: The AHI, LSaO₂ and ESS scores are significantly improved in the OSAHS patients after treated with SSLPW combined with soft palate radiofrequency coblation. The method is a valid option for the severe OSAHS patients.

Key words: obstructive sleep apnea hpopnea syndrome, stratified suture of lateral pharyngeal wall, radiofrequency ablation

中图分类号:

王伟倩, 李佳, 王曦, 冯勇, 卢雅艳, 赵娟, 徐金操. 咽侧壁分层缝合联合软腭低温等离子消融治疗重度阻塞性睡眠呼吸暂停低通气综合征患者的疗效[J]. 吉林大学学报(医学版), 2017, 43(03): 630-634.

WANG Weiqian, LI Jia, WANG Xi, FENG Yong, LU Yayan, ZHAO Juan, XU Jincao. Curative effect of stratified suture of lateral pharyngeal wall combined with soft palate radiofrequency coblation in treatment of patients with severe obstructive sleep apnea hypopnea syndrome[J]. Journal of Jilin University Medicine Edition, 2017, 43(03): 630-634.

参考文献

[1] Kum RO, Ozcan M, Yilmaz YF, et al. The relation of the obstruction site on muller's maneuver with BMI,neck circumference and PSG findings in OSAS[J].Otolaryngol Head Neck Surg, 2014, 66(2):167-172.
[2] Schwartz RN, Payne RJ, Forest VI, et al. The relationship between upper airway collapse and the severity of obstructive sleep apnea syndrome:a chart review[J]. Otolaryngol Head Neck Surg, 2015,44(4):32.
[3] Lan MC, Liu SY, Lan MY, et al. Lateral pharyngeal wall collapse associated with hypoxemia in obstructive sleep apnea[J]. Laryngoscope, 2015, 125(10):2408-2412.
[4] Schellenberg JB, Maislin G, Schwab RJ. Physical findings and the risk for obstructive sleep apnea. The importance of oropharyngeal structures[J]. Respir Crit Care Med, 2000, 162(2 Pt 1):740-748.
[5] 徐金操, 冯勇, 王伟, 等. 咽侧壁成形术联合软腭低温等离子消融治疗重度阻塞性睡眠呼吸暂停低通气综合征[J]. 中国耳鼻咽喉头颈外科, 2015, 22(1):41-43.
[6] 中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会咽喉学组. 阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44(2):95-96.
[7] Kim MJ, Kim BY, Lee DC, et al. A modified uvulopalatal flap with lateral pharyngoplasty for treatment in 92 adults with obstructive sleep apnoea syndrome[J]. Clin Otolaryngol, 2013, 38(5):415-419.
[8] Epstein LJ, Kristo D, Strollo PJ, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults[J]. Clin Sleep Med, 2009, 5(3):263-276.
[9] Ballester E, Badia JR, Hernández L, et al. Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome[J]. Respir Crit Care Med, 1999, 159(2):495-501.
[10] Young LR, Taxin ZH, Norman RG, et al. Response to CPAP withdrawal in patients with mild versus severe obstructive sleep apnea/hypopnea syndrome[J]. Sleep, 2013, 36(3):405-412.
[11] Soares D, Sinawe H, Folbe AJ, et al. Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery[J]. Laryngoscope, 2012, 122(2):473-479.
[12] Caples SM, Rowley JA, Prinsell JR, et al. Surgical modifications of the upper airway for obstructive sleep apnea in adults:a systematic review and meta-analysis[J]. Sleep, 2010, 33(10):1396-1407.
[13] 李树华, 暴继敏, 石洪金, 等. 阻塞性睡眠呼吸暂停低通气综合征围手术期严重并发症的处理及预防[J]. 中华耳鼻咽喉头颈外科杂志, 2010, 45(5):359-363.
[14] 隋海晶, 肖水芳, 秦永, 等. 等离子射频辅助的悬雍垂腭咽成形术后出血的临床研究[J]. 中华耳鼻咽喉头颈外科杂志, 2010, 45(10):830-834.
[15] 王琪, 王楠, 季青, 等. 阻塞性睡眠呼吸暂停低通气综合征研究在中国的发展-学术论文回顾(1983年~2005年)[J]. 中国耳鼻咽喉头颈外科, 2005, 12(10):628-631.
[16] Hessel NS, Vries N. Increase of the apnoea-hypopnoea index after uvulopalatopharyngoplasty:analysis of failure[J]. Clin Otolaryngol Allied Sci, 2004, 29(6):682-685.

咽侧壁分层缝合联合软腭低温等离子消融治疗重度阻塞性睡眠呼吸暂停低通气综合征患者的疗效

Curative effect of stratified suture of lateral pharyngeal wall combined with soft palate radiofrequency coblation in treatment of patients with severe obstructive sleep apnea hypopnea syndrome

RichHTML

PDF (PC)

赞

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 1

Metrics

本文评价

推荐阅读 0