关键词: 睡眠呼吸暂停,阻塞性;多平面手术;一期手术;序贯治疗

Abstract:

Objective   To analyze therapeutic effects, complications, total maintenance charge and total hospitalization days of 169 OSAHS cases, and to discuss the value of multiplanar operation of the upper airway in the treatment of moderate and severe OSAHS sufferers. Methods   The clinical data of 169 OSAHS patients who showed multiplannar blocking signs from August 2001 to January 2010, including operation scheme, PSG altogether with  Epworth sleepiness score before and after operation, total hospitalization expences and total hospitalization days, were reviewed. The advantages and disadvantages of different operation plans, rescuing experience and the tactics dealing with complications were discussed. Reasults   In the 169 OSAHS sufferers, 81 received one-stage multiplanar operation, including 70 nasal /palatopharyngeal plane operation, 9 palatopharyngeal/tongue base plane operations, and 2 H-UPPP/tongue base radiofrequency reduction/nasal ablations.29 chose consecutive surgical therapy in which nasal plane or palatopharyngeal plane operation was first done, and the operation on another plane done later. 59 acepted H-UPPP only. No death or serious complications occurred in the perioperation period and follow up(0.5 to 2 years). Epworth sleepiness score and PSG before and after operation were used to evaluate the therapeutic effects. Compared to the single H-UPP, one-stage multiplanar operation and consecutive multiplanar operation both showed advantages in decreasing AHI and ODI, but  no significant difference in decreasing  ESS or  raising SaO2min among the three types of operations was identified. The overall effective rates of the multiplanar operation group and the single H-UPPP group were 88.9%(72/81), 66.1%(39/59), respectively.  For single H-UPPP, the mean hospitalization charge was 7500±439 yuan, and the mean hospitalization stay was 9.8±1.3 days, while for the one-stage multi-planar operation group and consecutive multiplanaroperation group, the corresponding data were  10541±1043 yuan, 11.4±1.5 days, 14500±1097 yuan and  18.6±2.1 days. Complications, such as dysphagia, were more likely to happen in the one-stage multiplanar operation group(28/81)than the single H-UPPP group(7/59). Conclusions   Both one-stage multiplanar operation and consecutive multiplanar operation are better than single H-UPPP in the treatment of moderate and severe OSAHS sufferers who show multiplan blocking signs. And there is no significient difference bttween the therapeutic effects of one-stage multiplanar operation and consecutive multiplanar operation. Although the complications are more commonly seen the in onestage multiplanar operation group, no death or serious complications occurred. Also, one-stage operation can effectively decrease the cost of hospitalization, shorten hospital stay, and improve the curative rate.

Key words: Sleep apnea, obstructive; Multiplanar operation； One-stage operation； Sequential therapy