目的：探讨舌中线部分切除术治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者术后上气道结构的改变及疗效。方法65例行舌中线部分切除术后患者，手术前后行平静呼气末上气道CT扫描和三维重建，测量上气道舌咽平面的径线、截面积、气道单位容积及疗效指标。结果舌后气道的长度从术前（2.74±0.52）cm减少至术后（2.49±0.61）cm，前后径从术前（10.22±5.41）mm增加至术后（14.80±4.94）mm，最小截面积从术前（104.60±38.59）mm2增加至术后（177.98±61.00）mm2，单位容积从术前（2.74±1.50）mm3/cm增加至术后（5.08±2.28）mm3/cm，差异均有统计学意义（P<0.01）。呼吸暂停低通气指数（AHI）从术前（34.85±14.73）次/h减少至术后（17.59±8.39）次/h，最低血氧饱和度（LSaO2）从术前（0.64±0.14）增加至术后（0.75±0.08），上气道压力检查舌咽阻塞从术前（53.38±14.38）减少至术后（23.68±10.27），Epworth嗜睡量表（ESS）评分从术前（16.26±3.34）分减少至术后（7.62±1.83）分，差异均有统计学意义（P<0.01）。术后0.5年的有效率是69.2%，术后1年的有效率是64.6%，差异无统计学意义（P>0.05）。结论舌中线部分切除术用于合并舌咽平面阻塞的OSAHS患者安全有效。%Objective To explore upper airway changes and effectiveness with midline partial glossectomy in the treatment of obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods The upper airway in 65 patients with OSAHS were scanned during the end of normal respiration before and after treatment.To compare the efficacy,upper airway characteristics were measured following each procedure in 65 patients using a quantitative 3-D CT.The changes in the structure and efficacy were compared preoperatively and postoperatively.ResultsThe lengths of hypopharyngeal decreased from(2.74±0.52)cm to(2.49±0.61)cm;the anteroposterior diameter increased from(10.22±5.41)mm to(14.80±4.94)mm;the minimun cross-section area increased from(104.60±38.59)mm2 to(177.98±61.00)mm2;the minimun volume increased from(2.74±1.50) mm3/cm to(5.08±2.28)mm3/cm(P<0.01);the apnea hyponea index(AHI)decreased from(34.85±14.73) to(17.59±8.39);the lowest oxygen percent saturation(LSaO2)increased from(0.64±0.14)to(0.75±0.08); the scale of AG decreased from(53.38±14.38)to (23.68±10.27);Epworth sleeping scale(ESS)increased from(16.26±3.34)to(7.62±1.83)(P<0.01).The total effective rate was 69.2% six months after operation and 64.6% one year after operation(P>0.05).ConclusionMidline glossectomy was an effective and safe method in the treatment of OSAHS with hypopharyngeal airspace narrow.
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