Objective To compare the different postoperative changes of the pharynx in obstructive sleep apnea hypopnea syndrome (OSAHS) patients treated with H-uvulopalatopharyngoplasty (H-UPPP) combined with transpalatal advancement pharyngoplasty (PA) surgery or H-UPPP alone.Methods The upper airway in 43 patients with OSAHS were scanned during the end of normal respiration before and after treatment.There were 17 patients undergoing H-UPPP alone,26 patients undergoing H-UPPP combined with PA,with PSG before and after treatment.To compare the efficacy of H-UPPP with PA surgery or H-UPPP alone,upper airway characteristics were measured following each procedure in 43 patients using a quantitative 3-D CT.The 3-D CT measurement were made in lateral and anterior-posterior diameters,crosssection areas and volumes of retropalatal and retroglossal region.The changes in the structure of OSAHS patients treated with H-UPPP combined with PA surgery and H-UPPP alone were compared preoperatively and postoperatively,and the correction features that were presented in AHI and structural changes were analysed.Results The difference between H-UPPP combined with PA (n =26) and H-UPPP (n =17) in the changes in apnea hypopnea index (AHI) were (67.5 ± 18.9,38.7 ± 42.0,t =2.84,P ＜ 0.05),hard palate lengths were (4.50 ± 3.72) mm and (0.06 ± 0.22) mm (t =5.55,P ＜ 0.01) ; anteroposterior diameters of the hard palate level were (3.5 ± 4.3) mm and (-1.7 ± 4.4) mm(t =3.90,P ＜ 0.01) ; the minimum anteroposterior diameters of retropalatal were (1.2 ± 2.2) mm and (-1.2 ± 2.3) mm (t =-3.49,P ＜ 0.01) ; the minimum lateral diameters of retroglossal area were (4.9 ± 9.6) mm and (13.1 ±9.1)mm (t =2.80,P ＜ 0.01) preoperatively and postoperatively.The changes in the hard palate lengths were positively correlated to the change in AHI (r =0.407,P ＜ 0.01),also the change in anteroposterior diameter of the hard palate level (r =0.351,P ＜ 0.05),the minimum anteroposterior diameter of retropalatal area (r =0.381,P ＜ 0.01),and the minimum cross-section area of retropalatal (r =0.312,P ＜0.05).Conclusions H-UPPP combined with PA offers benefit over H-UPPP alone in OSAHS patients,which may be achieved by increased retropalatal airway size.Both the anteroposterior dimensions and the cross-area size are related with the efficacy of surgery.%目的 研究改良悬雍垂腭咽成形术(H-uvulopalatopharyngoplasty,H-UPPP)与H-UPPP联合软腭前移术(transpalatal advancement pharyngoplasty,PA)治疗阻塞性睡眠呼吸暂停低通气综合征患者术后上气道结构的变化特点,比较两种术式对上呼吸道结构改变的差异,筛选与疗效相关的结构改变指标.方法 回顾性选取43例经单纯H-UPPP术(17例)或H-UPPP联合PA手术治疗(26例)的患者.手术前后行多道睡眠监测及平静呼气末上气道CT扫描和三维重建,测量上气道不同区域的径线、截面积与气道单位容积等指标.分别比较各组手术前后CT测量值的改变量,对比不同术式的两组患者结构改变量的差异.分析手术前后病情程度改变和结构指标改变量的相关性.结果 H-UPPP联合PA组和单纯H-UPPP组手术前后呼吸暂停低通气指数(AHI)降低值平均(x-±s,下同)分别为(67.5±l8.9)次/h和(38.7±42.0)次/h,硬腭长度减小值分别为(4.50±3.72) mm和(0.06±0.22)mm,硬腭水平前后径增加值分别为(3.5±4.3)mm和(-1.7±4.4)mm,腭咽区气道最小前后径增加值分别为(1.2±2.2)mm和(-1.2±2.3)mm,联合手术组改善更明显,差异均有统计学意义(t值分别为2.84、5.55、3.90、-3.49,P值＜0.05或＜0.01).单纯H-UPPP组舌咽区气道最小左右径增加值(13.1±9.1)mm较H-UPPP联合PA组(4.9±9.6)mm大(t=2.80,P＜0.01).术后较术前AHI降低百分比与手术前后硬腭长度减小值、硬腭水平气道前后径增加值、腭咽区气道最小前后径增加值及腭咽区气道最小截面积增加值呈正相关趋势(r值分别为0.407、0.351、0.381、0.312,P值＜0.05或＜0.01).结论 H-UPPP联合PA术较单纯行H-UPPP术对AHI的降低作用更明显,其机制可能是通过更有效扩大腭咽区气道的前后径实现的.腭咽区气道面积和径线的增加与手术疗效相关.
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