Objective To observe the long-term results of midline partial glossectomy with uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). Methods Twenty-four severe OSAHS patients treated with midline partial glossectomy and UPPP from January 2003 to March 2004 were included in this study, the follow-up was 5 years. The median of preoperative lowest arterial oxygen saturation ( LSaO2) of this group at night (the same below) 0. 650, and AHI was 56. 5 times/h, UPPP was performed under general anesthesia, no tracheotomy performed. Criteria of curative effects; AHI <5 times/h was recovery, AHI <20 times/h and decreased beyond 50% marked improvement, only AHI decreased beyond 50% improvement. Results Post-operation AHI (6 months, 1 year, 2 years and 5 years after surgery) decreased significantly compared to that before the surgery, and post-operation LSaO2 was significantly higher than that of preoperative (Wilcoxon's signed rank test, the same below, P <0.01). The LSaO2 and AHI were significantly different between 1 year, 2 years, 5 years and 6 months post-operatively (P <0. 01). Six months after surgery, PSG results showed that 21 were recovery, marked improvement for the other 3 cases, the recovery rate was 87. 5%. One year after surgery, 18 were recovery, marked improvement in 3 cases, the recovery rate 75. 0%. Two years after surgery, 14 cases recovery, marked improvement in 4 cases, the recovery rate 58. 3%. Five years after surgery, 6 were recovery, the recovery rate 25. 0%. Among 5 cases with hypertension before the surgery, after surgery antihypertensive drugs were not necessary in 4 cases, and the dosage was decreased in 1 case. Conclusion The midline partial glossectomy with UPPP surgery may be an effective treatment for the severe OSAHS, long-term effect is satisfactory.%目的 观察舌后部中线切除术联合悬雍垂腭咽成形术(UPPP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的远期疗效.方法 回顾性分析24例2003年1月至2004年3月实施上述手术且有连续5年多道睡眠图(PSG)监测随访资料的重度OSAHS患者.患者术前夜间最低动脉血氧饱和度(SaO2)中位数(下同)0.650,AHI中位数56.5次/h,均于全麻下接受手术,围手术期均未行气管切开.疗效判定标准:AHI<5次/h为治愈,AHI<20次/h且降低幅度≥50%为显效,AHI降低幅度≥50%为有效.结果 24例患者术后0.5、1、2和5年AHI以及最低SaO2的中位数与术前相比.差异均有统计学意义(Wilcoxon秩和检验,下同,P值均<0.01);术后1、2与5年AHI和最低SaO2的中位数与术后半年相比差异也均有统计学意义(P值均<0.01).24例患者中术后半年治愈21例,显效3例,治愈率87.5%;术后1年,治愈18例,显效3例,有效3例,治愈率75.0%;术后2年,治愈14例,显效4例,有效6例,治愈率58.3%;术后5年治愈6例,显效12例,有效4例,无效2例,治愈率25%,有效率91.7%.术前5例合并高血压患者,4例术后停止应用降压药,1例由三种降压药联合应用减为单种药物,血压控制平稳.结论 舌后部中线切除联合UPPP手术可有效治疗腭后区及舌后区狭窄为主的重度OSAHS,虽有不同程度的复发现象,远期疗效还比较好.
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