山东大学耳鼻喉眼学报 ›› 2017, Vol. 31 ›› Issue (1): 50-54.doi: 10.6040/j.issn.1673-3770.0.2016.490

• 论著 • 上一篇    下一篇

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

怀德1,殷敏2,张希龙3,汪守峰1,解成兰4,徐敏5,戴俊1,蔡菁菁1,曹影1,金同爱1,程雷2   

  1. 1.徐州医科大学附属淮安医院/淮安市第二人民医院耳鼻咽喉科, 江苏 淮安 223002;
    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;
    3.南京医科大学第一附属医院/江苏省人民医院呼吸与危重症医学科, 江苏 南京 210029;
    4.徐州医科大学附属淮安医院/淮安市第二人民医院麻醉科, 江苏 淮安 223002;
    5.徐州医科大学附属淮安医院/淮安市第二人民医院影像科, 江苏 淮安 223002
  • 收稿日期:2016-11-21 出版日期:2017-02-16 发布日期:2017-02-16
  • 通讯作者: 程雷. E-mail:jspent@126.com
  • 基金资助:
    江苏省“333高层次人才培养工程”资助科研项目(BRA-2014131);江苏省淮安市2016年重点研发计划项目(社会发展)(HAS201611)

Modified UPPP with low-temperature plasma tongue volume reduction and selective nasal cavity expansion for moderate to severe OSAHS: short-term efficacy and safety evaluation.

  1. 1. Department of Otorhinolaryngology, Huaian Second Peoples Hospital, Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002, Jiangsu, China;2. Department of Otorhinolaryngology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China;3. Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China;4. Department of Anesthesiology, Huaian Second Peoples Hospital, Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002, Jiangsu, China;5. Department of Radiology, Huaian Second Peoples Hospital, Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002, Jiangsu, China;
  • Received:2016-11-21 Online:2017-02-16 Published:2017-02-16

PDF (PC)

1003

被引次数

3

摘要： 目的 探讨低温等离子辅助改良悬雍垂腭咽成形术(UPPP)、舌减容联合选择性鼻腔扩容术治疗中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的近期疗效、安全性及临床应用价值等。 方法 回顾分析淮安市第二人民医院耳鼻咽喉科2013年10月~2016年5月收治的164例中重度OSAHS患者,按手术方式不同分为观察组和对照组,每组82例患者。观察组在充分围手术期准备的基础上,采取低温等离子辅助改良UPPP、舌体舌根减容以及选择性鼻腔扩容术,对照组常规UPPP加鼻腔扩容术进行治疗。比较两组临床疗效、手术并发症情况等指标。 结果 术后随访6个月,观察组和对照组的总有效率分别为81.7%和62.2%,差异有统计学意义(P<0.05)。随访1年,观察组和对照组的总有效率分别为75.6%和51.2%,差异也有统计学意义(P<0.05)。观察组手术并发症发生率明显低于对照组(P<0.05)。 结论 对有手术适应证的中重度OSAHS行低温等离子辅助改良UPPP联合舌减容和选择性鼻腔扩容术,可取得较为满意的治疗效果,安全性良好,但术后1年以上的远期疗效有待进一步随访观察。

关键词: 悬雍垂腭咽成形术, 鼻腔扩容术, 舌减容术, 睡眠呼吸暂停,阻塞性, 低温等离子

Abstract: Objective To explore the clinical efficacy, safety and value of modified uvulopalatopharyngoplasty(UPPP)versus low-temperature plasma and selective nasal cavity vasodilatation with tongue volume reduction in the treatment of moderate and severe obstructive sleep apnea hypopnea syndrome(OSAHS). Methods The clinical data of 164 patients with moderate or serious OSAHS treated during Octorber, 2013 and May, 2016 were retrospective analyzed. According to the different surgical approaches, patients were divided into two groups: the observation group(n=82)and the control group(n=82). Patients in the observation group received modified UPPP versus low-temperature plasma and selective nasal cavity vasodilatation with tongue volume reduction, while patients in the control group underwent routine UPPP and nasal cavity vasodilatation. The clinic efficacy, operative complications, postoperative relapse and other indexes of the two groups were compared. Results Six months after surgery, the general effective rate of the observation group and control group was 81.7% and 62.2%, respectively, with statistically significant difference(P<0.05). One year after surgery, the general effective rate of the observation group and control group was 75.6% 山东大学耳鼻喉眼学报31卷1期 -怀德,等.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 \=-and 51.2%, respectively, with statistically significant difference(P<0.05). Fewer complications occurred in the observation group than in the control group. Conclusion The efficacy of modified UPPP plus low-temperature plasma and selective nasal cavity vasodilatation with tongue volume reduction can produce satisfactory clinical outcome for patients with moderate or severe OSAHS.

Key words: Sleep apnea, obstructive, Uvulopalatopharyngoplasty, Tongue volume reduction, Nasal cavity expansion, Low-temperature plasma

中图分类号: 

  • R766.7
[1] Hassid S, Afrapoli AH, Decaestecker C, et al. UPPP for snoring: long-term results and patient satisfaction[J]. Acta Otorhinolaryngol Belg, 2002, 56(2):157-162.
[2] Friedman M, Ibrahim H, Bass L. Clinical staging for sleep-disordered breathing[J]. Otolarynglology Head Neck Surg, 2002, 127(1):13-21.
[3] Friedman M, Ibrahim H, Joseph NJ. Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment[J]. Laryngoscope, 2004, 114:454-459
[4] Delong Liu, Qingfeng Zhang. Anatomic characteristics of tongue coblation[J]. Otolarynglology-Head and Neck Surgery, 2008, 139(supplement, 2S1):199-200.
[5] 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.
[6] 张宝林, 郭睿, 龚维熙, 等. 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. ZHANG Baolin, GUO Rui, GONG Weixi, et al. Reducing the volume of soft palate and tongue with low-temperature plasma combined with pharyngeal mucosal relaxation suture in patients with obstructive sleep apnea hypopnea syndrome[J]. J Otolaryngol Ophthalmol Shandong Univ, 2015, 29(5):19-22.
[7] 蒋新霞, 任秀敏, 王宝山. 低温等离子射频消融治疗阻塞性睡眠呼吸暂停低通气综合征32例[J]. 山东大学耳鼻喉眼学报,2006,20(2):184-185. JIANG Xinxia, REN Xiumin, WANG Baoshan. Low temperature plasma radiofrequency ablation in treatment of 32 patients with obstructive sleep apnea hypopnea syndrome[J]. J Otolaryngol Ophthalmol Shandong Univ, 2006, 20(2):184-185.
[8] 赵源庆, 袁勇, 公蕾, 等. 悬雍垂腭咽成形术中扩大咽峡和鼻咽峡的特点[J]. 中国组织工程研究与临床康复, 2007, 11(12):2393-2396. ZHAO Qingyuan, YUAN Yong, GONG Lei, et al. Dilatation of oropharyngeal and nasopharyngealisthmus in uvulopalatopharyngoplasty[J]. Chin J Tissue Eng Res, 2007, 11(12):2393-2396.
[9] 韩德民, 臧洪瑞. 鼻腔扩容技术[J]. 中国医学文摘(耳鼻咽喉科学), 2009, 24(4):197-199.
[10] Kanagalingam J, Rajeswaran R, Koteeha B. Long-term outcomes of laser-assisted uvulopalatoplaaty in 168 patients with snoring[J]. Laryngol Otol, 2006, 120:932-938.
[11] 赵晨, 李笑天, 刘亚奇, 等. 阻塞性睡眠呼吸暂停低通气综合征术后复发原因分析及再手术治疗研究[J]. 临床耳鼻咽喉头颈外科杂志,2013, 12:626-628. ZHAO Chen, LI Xiaotian, LIU Yaqi, et al. Research on failure reasons of surgical treatment of obstructive sleep apnea hypopnea syndrome and reoperation method[J]. Clin J Otorhinolarynol Head Neck Surg, 2013, 12:626-628.
[12] 洪燕丽, 李兆生, 沈伟林, 等. 改良悬雍垂腭咽成形术联合鼻部同期手术治疗重度阻塞性睡眠呼吸暂停低通气综合征分析[J]. 中国耳鼻咽喉头颈外科, 2013,20(7):370-372. HONG Yanli, LI Zhaosheng, SHEN Weilin, et al. Modified uvulopalatopharyngoplasty combined with one stage nasal surgery for patients with severe obstructive sleep apnea hypopnea syndrome[J]. Chin Otolaryngol Otolaryngol Head Neck Surg, 2013, 20(7):370-372.
[13] 张芳君, 邵军, 钱蔚颖, 等. 多平面手术联合治疗重度阻塞性睡眠呼吸暂停低通气综合征的临床观察[J]. 中国耳鼻咽喉颅底外科杂志,2013,19(1):19-23. ZHANG Fangjun, SHAO Jun, QIAN Weiying, et al. Evaluation of multi-level surgery for severe obstructive sleep apnea hypopnea syndrome[J]. Chin J Otorhinolaryngol Skull Base Surg, 2013, 19(1):19-23.
[14] 怀德, 王海旭, 曹影, 等. CO2激光辅助改良腭咽成形加选择性鼻腔扩容术治疗中重度阻塞性睡眠呼吸暂停低通气综合征[J]. 中华临床医师(电子版), 2016, 10(17):2543-2546. HUAI De, WANG Haixu, CAO Ying, et al. Improvement of CO2 laser assisted uvulopalatopharyngoplasty with selective expansion of the nasal cavity for the treatment of the moderate to severe obstructive sleep apnea hypopnea syndrome[J]. Chin J Clinicians(Electronic Ed), 2016, 10(17):2543-2546.
[15] 王海旭, 怀德, 曹影. 等. CO2激光辅助改良腭咽成形加选择性鼻腔扩容术治疗阻塞性睡眠呼吸暂停低通气综合征的疗效观察[J]. 中国中西医结合耳鼻咽喉科杂志, 2016, 24(4):272-275. WANG Haixu, HUAI De, CAO Ying, et al. Improvement of CO2 laser assisted uvulopalatopharyngoplasty with selective expansion of the nasal cavity for the treatment of the obstructive sleep apnea hypopnea syndrome[J]. Chin J Otorhinolaryngol Integ Med, 2016, 24(4):272-275.
[16] De Huai, Jun Dai, Min Xu, et al. Combination of CO2 laser-assisted uvulopalatopharyngoplasty and nasal cavity expansion enhances treatment of obstructive sleep apnea-hypopnea syndrome[J]. Int J Clin Exp Med, 2015, 8(10):19764-19774.
[17] 张庆丰. 耳鼻咽喉等离子手术学[M]. 北京: 人民卫生出版社, 2014:133-134.
[1] 马馨,董凌康,吴红敏,易红良,邹建银. 外展悬吊缝合技术在阻塞性睡眠呼吸暂停治疗中的改良及应用进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 81-88.
[2] 佘志强,刘继远. 不典型喉旁间隙异物1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2023, 37(3): 60-63.
[3] 李定波,唐志元,邓智毅,曾宪海,张秋航,王再兴. 低温等离子射频消融术治疗药物性鼻炎27例[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 11-17.
[4] 朱晶,张睿,赵媛,李炀,樊孟耘,赵昱. 内镜下低温等离子消融治疗不同炎症分期先天性梨状窝瘘45例[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 24-29.
[5] 韩继波,董洁,明伟,王燕,罗志宏. 不同睡眠分期血氧饱和度差值对悬雍垂腭咽成形术手术预后评估价值[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 73-78.
[6] 李利杰,田秀芬. CO2激光联合低温等离子治疗早期声门型喉癌40例[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 79-85.
[7] 张旻, 刘永亮, 宋道亮, 韩学锋, 封新荣, 赵允沛. 鼻内镜下改良下鼻甲成形术与下鼻甲低温等离子消融加骨折外移术治疗重度慢性肥厚性鼻炎的临床对比研究[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 83-88.
[8] 牛子捷,肖洋,王军,马丽晶. 喉乳头状瘤手术治疗的研究进展[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 96-100.
[9] 沈瑶,周成勇. 低温等离子辅助下儿童扁桃体全切除与部分切除的比较[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 22-27.
[10] 朱华明,关建,茆松,张维天,易红良. 低温等离子射频消融辅助咽旁间隙良性肿瘤切除的应用分析[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 28-33.
[11] 李健忠,周永锐,李慧英,李妙编,孙一涤,邱前辉. 彩超引导低温等离子消融术在甲状腺良性结节的临床应用研究[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 34-38.
[12] 孙川,刘亚群,何双八,张庆翔. 低温等离子辅助经鼻切除前中颅底肿瘤17例[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 55-59.
[13] 肖旭平,周恩,肖禹. 等离子点状激发射频消融技术治疗早期声门型喉癌(Tis-T1b)31例[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 60-66.
[14] 王胜国,陈志太,周本忠,李龙巧,史先萍,吴飞凤,张泽生. 鼻内镜下联合低温等离子刀切除鼻腔鼻窦内翻性乳头状瘤37例[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 67-70.
[15] 吴华,孙永明,郑建华,蔡雪花. 腺样体消融联合鼓膜打孔术治疗儿童腺样体肥大合并分泌性中耳炎55例[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 71-75.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发