咽侧壁分层缝合联合软腭低温等离子消融治疗重度阻塞性睡眠呼吸暂停低通气综合征患者的疗效

摘要

目的:探索咽侧壁分层缝合(SSLPW)联合软腭低温等离子消融治疗重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的可行性和临床效果.方法:收集行咽侧壁成形术(LP)联合软腭低温等离子消融术治疗的21例重度OSAHS患者(LP组)和行SSLPW联合软腭低温等离子消融术治疗的39例重度OSAHS患者(SSLPW组)的临床资料,回顾性分析2组患者术前和术后呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(LSaO2)、Epworth嗜睡量表(ESS)评分及术后相关并发症发生情况,并比较2组患者的手术成功率.结果:LP组患者治愈1例(5%),显效19例(90%),有效1例(5%),无效0例,手术成功率为95.2%(20/21);SSLPW组患者治愈2例(5.1%),显效33例(84.6%),有效4例(10.3%),无效0例,手术成功率为89.7%(35/39);2组患者手术成功率比较差异无统计学意义(P>0.05).2组患者主观症状均明显改善,术后1个月随访未出现鼻咽部反流及吞咽困难.与术前比较,2组患者术后AHI和ESS评分降低(P<0.05),LSaO2升高(P<0.05).结论:SSLPW联合软腭低温等离子消融术后患者AHI、LSaO2及ESS评分均改善明显,其可以作为治疗重度OSAHS患者的良好手段.%Objective:To explore the feasibility and clinical efficacy of stratified suture of lateral pharyngeal wall(SSLPW) combined with soft palate radiofrequency coblation in the treatment of the patients with severe obstructive sleep apnea hypopnea syndrome(OSAHS).Methods:The clinical data of 21 severe OSAHS patients underwent lateral pharyngoplasty(LP) combined with soft palate radiofrequency coblation (LP group) and 39 severe OSAHS patients underwent SSLPW combined with soft palate radiofrequency coblation (SSLPW group) were selected.The apnea hypopnea index(AHI),lowest SaO2(LSaO2),Epworth sleepiness scale(ESS) scores,and related postoperative complications of the patients in two groups were analyzed before and after operation.The successful rates of operation of the patients in two were compared.Results:In LP group,1 patient was cured (5%),19 patients were improved markedly (90%),1 patient was effective (5%),and no patient was invalid;the successful rate was 95.2%(20/21).In SSLPW group,2 patients were cured (5.1%),33 patients were improved markedly (84.6%),4 patients were effective (10.3%),and no patients was invalid;the successful rate was 89.7%(35/39);there was no statistical difference in the successful rate of operation of the patients between two groups (P>0.05).There was statistically significant improvement of the subjective symptoms.All the patients returned to normal subjective swallowing functions without nasal pharyngeal reflux and dysphagia in one month follow-up after operation.Compared with before operation,the AHI and ESS scores of the patients in two groups after operation were decreased(P<0.05);the LSaO2 scores were increased(P<0.05).Conclusion:The AHI,LSaO2 and ESS scores are significantly improved in the OSAHS patients after treated with SSLPW combined with soft palate radiofrequency coblation.The method is a valid option for the severe OSAHS patients.