山东大学耳鼻喉眼学报 ›› 2017, Vol. 31 ›› Issue (1): 64-69.doi: 10.6040/j.issn.1673-3770.0.2017.036

• 综述 • 上一篇    下一篇

阻塞性睡眠呼吸暂停患者软腭平面的手术方式及其应用

李静1综述, 殷敏2,程雷2审校   

  1. 1.南京医科大学附属江宁医院耳鼻咽喉科, 江苏 南京 211100;
    2.南京医科大学第一附属医院/江苏省人民医院耳鼻咽喉科, 江苏 南京 210029
  • 收稿日期:2017-01-23 出版日期:2017-02-16 发布日期:2017-02-16
  • 通讯作者: 殷敏. E-mail: simisodo@126.com

Surgical procedures and application of uvulopalatopharyngoplasty and its modified methods in patients with obstructive sleep apnea.

  1. Department of Otorhinolaryngology, 1. Affiliated Jiangning Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu, China;2. The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu, China
  • Received:2017-01-23 Online:2017-02-16 Published:2017-02-16

摘要: 阻塞性睡眠呼吸暂停综合征(OSAS)患者中常见软腭平面狭窄,解除该平面狭窄最经典的手术方式是悬雍垂腭咽成形术(UPPP)。本文以UPPP为基础,对OSAS患者软腭平面的各种手术方式及疗效进行综述。

关键词: 软腭, 悬雍垂腭咽成形术, 改良悬雍垂腭咽成形术, 睡眠呼吸暂停,阻塞性

Abstract: The stenosis soft palate level is common in patients with obstructive sleep apnea syndrome(OSA)and uvulopalatopharyngoplasty(UPPP)is the classic method to relieve the obstructive sites. This review mainly describes surgical procedures of UPPP and its modified methods and theirs efficacy in the treatment of OSA.

Key words: Soft palate, Uvulopalatopharyngoplasty, Sleep apnea, obstructive, Modified uvulopalatopharyngoplasty

中图分类号: 

  • R766.7
[1] Fujita S, Conway W, Zorick F, et al. Surgical correction of anatomic azbnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty[J]. Otolaryngol Head Neck Surg, 1981, 89(6):923-934.
[2] Walker-Engstrom ML, Tegelberg A, Wilhelmsson B, et al. 4-year follow-up of treatment with dental appliance or uvulopalatopharyngoplasty in patients with obstructive sleep apnea: a randomized study[J]. Chest, 2002, 121(3):739-746.
[3] Vilaseca I, Morello A, Montserrat JM, et al. Usefulness of uvulopalatopharyngoplasty with genioglossus and hyoid advancement in the treatment of obstructive sleep apnea[J]. Arch Otolaryngol Head Neck Surg, 2002, 128(4):435-440.
[4] Hernandez SF. Palatopharyngoplasty for the obstructive sleep apnea syndrome:technique and preliminary report of results of ten patients[J]. Am J Otolaryngol, 1982, 3(4):229-234.
[5] Caldarelli DD, Cartwright R, Lilie JK. Severity of sleep apnea as a predictor of successful treatment by palatopharyngoplasty[J]. Laryngoscope, 1986, 96(9 Pt 1):945-947.
[6] Friedman M, Ibrahim HZ, Vidyasagar R, et al. Z-palatoplasty(ZPP): a technique for patients without tonsils[J]. Otolaryngol Head Neck Surg, 2004, 131(1):89-100.
[7] Wang L, Liu JX, Yang XL, et al. Z-palatoplasty and tongue radiofrequency for patients with small tonsils[J]. Otolaryngol Head Neck Surg, 2013, 148(5):873-877.
[8] Friedman M, Duggal P, Joseph NJ. Revision uvulopalatoplasty by Z-palatoplasty[J]. Otolaryngol Head Neck Surg, 2007, 136(4):638-643.
[9] Michael Friedman MD, FACS, Michelle S. Hwang BS. Z-palatopharyngoplasty[J]. Oper Tech Otolaryngol, 2015, 26(2):90-94.
[10] 金新,王君影,顾东生,等. 改良Z形腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征的疗效分析[J]. 重庆医学,2013,42(1):71-73.
[11] Yi HL, Sun XQ, Chen B, et al. Z-palatopharyngoplasty plus genioglossus advancement and hyoid suspension for obstructive sleep apnea hypopnea syndrome[J]. Otolaryngol Head Neck Surg, 2011, 144(3):469-473.
[12] Yi HL, Yin SK, Zhang YJ, et al. Z-palatopharyngoplasty for obstructive sleep apnea/hypopnea syndrome[J]. Otolaryngol Head Neck Surg, 2009, 140(5):640-645.
[13] 韩德民,王军,叶京英. 腭咽成形术中保留悬雍垂的意义[J]. 中华耳鼻咽喉科杂志, 2000, 35(3):215.
[14] 付忠良,张峰,何岩,等. 切除部分腭咽肌的改良UPPP术后疗效观察[J]. 临床耳鼻咽喉头颈外科杂志,2013,27(12):621-625.
[15] Han D, Xu W, Hu R, et al. Voice function following Han's uvulopalatopharyngoplasty[J]. J Laryngol Otol, 2012, 126(1):47-51.
[16] Truy E, Cote-Deplus I, Morgon A. Effectiveness of musculus palatopharyngeus resection in uvulopalatopharyngoplasty for snoring[J]. J Otolaryngol, 1995, 24(2):79-83.
[17] Cahali MB. Lateral pharyngoplasty: a new treatment for obstructive sleep apnea hypopnea syndrome[J]. Laryngoscope, 2003, 113(11):1961-1968.
[18] de Paula SC, Cavichio L, Cahali MB. Lateral pharyngoplasty reduces nocturnal blood pressure in patients with obstructive sleep apnea[J]. Laryngoscope, 2014, 124(1):311-316.
[19] Elbassiouny AM. Soft palatal webbing flap palatopharyngoplasty for both soft palatal and oropharyngeal lateral wall collapse in the treatment of snoring and obstructive sleep apnea: a new innovative technique without tonsillectomy[J]. Sleep Breath, 2015, 19(2):481-487.
[20] Shin SH, Ye MK, Kim CG. Modified uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea-hypopnea syndrome: resection of the musculus uvulae[J]. Otolaryngol Head Neck Surg, 2009, 140(6):924-929.
[21] 吴昊,尤易文,王强,等. 悬雍垂肌部分切除保留黏膜的UPPP临床应用[J]. 临床耳鼻咽喉头颈外科杂志, 2011(6):262-264. WU Hao, YOU Yiwen, WANG Qiang, et al. Clinical application of uvulopalatopharyngoplasty with resection of the musculus uvulae and preservation of uvulae mucosa[J]. J Clin Otorhinolaryngol Head Neck Surg, 2011(6):262-264.
[22] Mackay SG, Carney AS, Woods C, et al. Modified uvulopalatopharyngoplasty and coblation channeling of the tongue for obstructive sleep apnea: a multi-centre Australian trial[J]. J Clin Sleep Med, 2013, 9(2):117-124.
[23] Kwon M, Jang YJ, Lee BJ, et al. The effect of uvula-preserving palatopharyngoplasty in obstructive sleep apnea on globus sense and positional dependency[J]. Clin Exp Otorhinolaryngol, 2010, 3(3):141-146.
[24] Cho KS, Koo SK, Lee JK, et al. Limited palatal muscle resection with tonsillectomy:a novel palatopharyngoplasty technique for obstructive sleep apnea[J]. Auris Nasus Larynx, 2014, 41(6):558-562.
[25] 宁博,郭星,洪兴和. 改良UPPP与传统UPPP治疗阻塞性睡眠呼吸暂停低通气综合征的疗效比较[J]. 临床耳鼻咽喉杂志,2006,20(18):825-827. NING Bo, GUO Xing, HONG Xinghe. Contrast the curative effect of the improved UPPP and traditional UPPP in treating OSAHS[J]. J Clin Otorhinolaryngol,2006,20(18):825-827.
[26] Lim DJ, Kang SH, Kim BH, et al. Treatment of primary snoring using radiofrequency-assisted uvulopalatoplasty[J]. Eur Arch Otorhinolaryngol, 2007, 264(7):761-767.
[27] Walker RP, Grigg-Damberger MM, Gopalsami C. Uvulopalatopharyngoplasty versus laser-assisted uvulopalatoplasty for the treatment of obstructive sleep apnea[J]. Laryngoscope, 1997, 107(1):76-82.
[28] Skatvedt O. Laser-assisted uvulopalatoplasty: description of the technique and pre- and postoperative evaluation of subjective symptoms[J]. ORL J Otorhinolaryngol Relat Spec, 1996, 58(5):243-247.
[29] Carenfelt C. Laser uvulopalatoplasty in treatment of habitual snoring[J]. Ann Otol Rhinol Laryngol, 1991, 100(6):451-454.
[30] Haraldsson PO, Bredbacka S. Laser-uvulopalatoplasty(LUPP)under local anesthesia:effective, safe and comfortable[J]. ORL J Otorhinolaryngol Relat Spec, 1996, 58(2):99-104.
[31] Yoruk O, Akgun M, Sutbeyaz Y, et al. Treatment of primary snoring using modified radiofrequency-assisted uvulopalatoplasty[J]. Eur Arch Otorhinolaryngol, 2009, 266(11):1807-1814.
[32] Zinder DJ, Postma GN. Outpatient cautery-assisted uvulopalatoplasty[J]. Laryngoscope, 1995, 105(11):1256-1257.
[33] 陈雄,肖英,何烈纯,等. 低温等离子辅助悬雍垂腭咽成形术与常规手术并发症的比较[J]. 中华耳鼻咽喉头颈外科杂志, 2012, 47(2):101-106. CHEN Xiong, XIAO Ying, HE Liechun, et al. Comparation between modified coblation assisted uvulopalatopharyngoplasty and conventional uvulopalatopharyngoplasty in operative complication[J]. Chin J Otorhinolaryngol Head Neck Surg, 2012, 47(2):101-106.
[34] 罗志强,敬前程. H-UPPP及等离子辅助的H-UPPP治疗OSAHS的临床对比研究[J]. 临床耳鼻咽喉头颈外科杂志, 2011, 25(6):258-261. LUO Zhiqiang, JING Qiancheng. Comparision of H-uvulopalatopharyngoplasty and plasma-assisted H-uvulopalatopharyngoplasty in the treatment of obstructive sleep apnea hypopnea syndrome[J]. J Clin Otorhinolaryngol Head Neck Surg, 2011, 25(6):258-261.
[35] Salami A, Dellepiane M, Bavazzano M, et al. New trends in head and neck surgery: a prospective evaluation of the Harmonic Scalpel[J]. Med Sci Monit, 2008, 14(5): PI1-5.
[36] Mora R, Jankowska B, Crippa B, et al. Effects of uvulopalatopharyngoplasty with Harmonic Scalpel on speech and voice[J]. Eur Arch Otorhinolaryngol, 2009, 266(12):1989-1994.
[37] Salami A, Dellepiane M, Bavazzano M, et al. Harmonic Scalpel vs “cold knife” dissection in uvulopalatopharyngoplasty[J]. Am J Otolaryngol, 2010, 31(6):442-447.
[38] 冯旭,黄志纯,朱新,等. 超声刀在保留悬雍垂腭咽成形术中的应用[J]. 临床耳鼻咽喉头颈外科杂志, 2013, 27(12):633-636.
[39] Powell NB, Riley RW, Troell RJ, et al. Radiofrequency volumetric tissue reduction of the palate in subjects with sleep-disordered breathing[J]. Chest, 1998, 113(5):1163-1174.
[40] Emery BE, Flexon PB. Radiofrequency volumetric tissue reduction of the soft palate:a new treatment for snoring[J]. Laryngoscope, 2000, 110(7):1092-1098.
[41] Lee LA, Yu JF, Lo YL, et al. Comparative effects of snoring sound between two minimally invasive surgeries in the treatment of snoring: a randomized controlled trial[J]. PLoS One, 2014, 9(5):e97186.
[42] Pang KP, Siow JK. Sutter bipolar radiofrequency volumetric tissue reduction of palate for snoring and mild obstructive sleep apnoea: is one treatment adequate?[J]. J Laryngol Otol, 2009, 123(7):750-754.
[43] Johnson JT, Vates J, Wagner RL. Reduction of snoring with a plasma-mediated radiofrequency-based ablation(Coblation)device[J]. Ear Nose Throat J, 2008, 87(1):40-43.
[44] 纪维纲,姜小兵,叶星,等. 射频等离子手术治疗阻塞性睡眠呼吸暂停低通气综合征[J]. 中华耳鼻咽喉科杂志, 2003, 38(3):235-236.
[45] 陈仕虎,蒲晓兵,周蔚,等. 低温等离子扁桃体减容术99例临床疗效观察[J]. 华西医学, 2004, 19(4):549. CHEN Shihu, PU Xiaobing, ZHOU Wei, et al. Efficacy of coblation tissue volume reduction of tonsils(report of 99 cases)[J]. West Chin Med J, 2004, 19(4):549.
[46] 郭兮恒,王辰,张洪玉,等. 低温射频等离子术治疗鼾症和阻塞性睡眠呼吸暂停综合征的临床观察[J]. 中华医学杂志, 2001, 81(21):29-31. GUO Xihen, WANG Chen, ZHANG Hongyu, et al. Application of plasma radiofrequency at low temperature in treatment of snoring and obstructive sleep apnea syndrome: a pilot study[J]. Nat Med J Chin, 2001, 81(21):29-31.
[47] Walker RP, Levine HL, Hopp ML, et al. Palatal implants: a new approach for the treatment of obstructive sleep apnea[J]. Otolaryngol Head Neck Surg, 2006, 135(4):549-554.
[48] Nordgard S, Hein G, Stene BK, et al. One-year results: palatal implants for the treatment of obstructive sleep apnea[J]. Otolaryngol Head Neck Surg, 2007, 136(5):818-822.
[49] Neruntarat C. Long-term results of palatal implants for obstructive sleep apnea[J]. Eur Arch Otorhinolaryngol, 2011, 268(7): 1077-1080.
[50] Neruntarat C, Chantapant S. Palatal Suspension and Uvulopalatopharyngoplasty for Obstructive Sleep Apnea[J]. Int Med J, 2010, 17(3):213-217.
[51] Woodson BT, Toohill RJ. Transpalatal advancement pharyngoplasty for obstructive sleep apnea[J]. Laryngoscope, 1993, 103(3):269-276.
[52] Woodson BT, Robinson S, Lim HJ. Transpalatal advancement pharyngoplasty outcomes compared with uvulopalatopharygoplasty[J]. Otolaryngol Head Neck Surg, 2005, 133(2):211-217.
[53] 叶京英, 伊彪, 刘静明, 等. 软腭前移悬雍垂腭咽成形术[J]. 中华耳鼻咽喉头颈外科杂志, 2007, 42(2):85-89.
[54] Shine NP, Lewis RH. Transpalatal advancement pharyngoplasty for obstructive sleep apnea syndrome: results and analysis of failures[J]. Arch Otolaryngol Head Neck Surg, 2009, 135(5):434-438.
[1] 李浩,李延忠,王岩. HIF-1α、VEGF在阻塞性睡眠呼吸暂停低通气综合征患者[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 43-47.
[2] 霍红,李五一,王剑,杨大海,金晓峰,田旭,牛燕燕. 等离子辅助悬雍垂腭咽成形术后重度咽狭窄的治疗[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 58-61.
[3] 刘文君,于雪莹,吕丹,陈正岗,张艳青,梅栩彬,杨珂. 不同性别阻塞性睡眠呼吸暂停低通气综合征患者与上气道影像学相关性的研究[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 54-59.
[4] 怀德,殷敏,张希龙,汪守峰,解成兰,徐敏,戴俊,蔡菁菁,曹影,金同爱,程雷. 低温等离子辅助改良腭咽成形联合舌减容和鼻腔扩容术对中重度OSAHS的近期疗效和安全性评价[J]. 山东大学耳鼻喉眼学报, 2017, 31(1): 50-54.
[5] 李静,史雅文,李佳宸,殷敏,程雷. 阻塞性睡眠呼吸暂停低通气综合征患者软腭平面手术疗效的Meta分析[J]. 山东大学耳鼻喉眼学报, 2017, 31(1): 55-63.
[6] 包扬,王春玲,张丽,金敏,周长青,潘新良. 帕瑞昔布钠联合曲马多镇痛对悬雍垂腭咽成形术患者的影响[J]. 山东大学耳鼻喉眼学报, 2016, 30(5): 49-53.
[7] 史春海,商晓敏,刘富超,唐维维,黑任轶,李树华. 阻塞性睡眠呼吸暂停低通气综合征患者腭舌比值与症状程度的相关性分析[J]. 山东大学耳鼻喉眼学报, 2016, 30(5): 24-28.
[8] 张宝林, 郭睿, 龚维熙, 马坚凌, 李现龙. 软腭、舌根舌体低温等离子消融配合咽黏膜减张缝合治疗阻塞性睡眠呼吸暂停低通气综合征[J]. 山东大学耳鼻喉眼学报, 2015, 29(5): 19-22.
[9] 唐智, 王继群, 涂智峰, 陈勇明, 李贵娣, 李玉兰, 刘玲玲. 合并Ⅰ、Ⅱ型阻塞性睡眠呼吸暂停低通气综合征的手术疗效[J]. 山东大学耳鼻喉眼学报, 2015, 29(4): 1-3.
[10] 苏跃, 王中亮, 曾珍. 三种手术方式在改良悬雍垂腭咽成形术中的疗效对比[J]. 山东大学耳鼻喉眼学报, 2015, 29(1): 5-7.
[11] 刘洪, 刘天悦, 王春娇, 王娟. 改进软腭牵拉暴露鼻咽手术治疗腺样体肥大[J]. 山东大学耳鼻喉眼学报, 2015, 29(1): 89-90.
[12] 王玉芝, 吕凌燕, 曲喆, 王兴杰, 周宣岩. 重度OSAHS并高血压患者行悬雍垂腭咽成形术前后血压变化分析[J]. 山东大学耳鼻喉眼学报, 2014, 28(5): 7-9.
[13] 李永强,张文山. 局麻下两切口行保留悬雍垂的腭咽成形术治疗大扁桃体导致的中度OSAHS[J]. 山东大学耳鼻喉眼学报, 2014, 28(1): 67-69.
[14] 徐伟伟,李建东,刘春宁,张志莉. 改良悬雍垂腭咽成形术对阻塞性睡眠呼吸暂停低通气综合征患者血压、心律的影响[J]. 山东大学耳鼻喉眼学报, 2013, 27(4): 11-13.
[15] 李吉洲,韩丽,宋建京. 重症阻塞性睡眠呼吸暂停低通气综合征的阻塞平面及疗效分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(4): 14-16.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!