Objective: The upper airway anatomy of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) was measured using electronic nasopharyngeal lens, used to guide the precise resection of the soft palate range during the modified sarsaovatopharynthoplasty and improve the surgical efficacy. Methods: From February to October 2020, The length of the palate and the distance of Passvant's ridgy on the posterior pharyngeal wall of 38 patients with type II OSAHS,in a conscious state,were measured by electronic nasopharyngoscope via nose before operation,the improved operating methods witch the free edge of the soft palate and the uvula were preserved completely were adopted,and the longer soft palate tissue was removed.The average length of the excised soft palate was 10.3±3.7(mm). The length of the palate and the distance of Passvant's ridgy were reviewed during 6-12 months postoperative follow-up, and postoperative complications and clinical efficacy were observed. Results: According to the preoperative measurement results by electronic nasopharyngoscope, the postoperative clinical symptoms with the patients underwent modified uvulopalatopharyngoplasty after excision of the longer soft palate tissue were significantly improved without common postoperative complications. PSG was significantly improved before and after operation, and the curative effect was statistically significant (P＜0.05). Conclusion: Using electronic nasopharyngoscope to measure the upper airway anatomical structure of the patients with type II OSAHS for surgical treatment could provide an accurate range of soft palate to be resected, effectively prevent postoperative complications and improve surgical efficacy.
XUE Zhangwei
,
LIAO Zhiping
. The role of electronic nasopharyngoscope in the evaluation of excising the soft palate range with modified UPPP[J]. Journal of Baotou Medical College, 2023
, 39(4)
: 62
-67
.
DOI: 10.16833/j.cnki.jbmc.2023.04.013
[1] 中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].中华结核和呼吸杂志,2012,35(1):9-12.
[2] 夏菲, 王宁宇.悬雍垂腭咽成形术后并发症及其预防[J]. 中国眼耳鼻喉科杂志,2008,8(6):401-403.
[3] Huang TW, Cheng PW. Microdebrider-assisted extended uvulopalatoplasty: an effective and safe technique for selected patients with obstructive sleep apnea syndrome[J]. Arch Otolaryngol Head Neck Surg, 2008,134(2):141-145.
[4] 袁梦凡, 高英, 王娜娜,等. CT测量在阻塞性睡眠呼吸暂停低通气综合征诊断与治疗中的应用进展[J]. 中国医学工程,2019,27(2):40-43.
[5] 赵宁, 付忠良, 杨怀安, 等. 鼻咽3D-CT检查对OSAHS患者术前评估的临床意义[J]. 大连医科大学学报,2015,37(6):564-566,570.
[6] 胡德余, 苏苗赏, 林全任, 等.多层螺旋CT在肥胖OSAHS上气道阻塞评估中的应用价值[J]. 医学研究杂志,2017,46(5):94-98.
[7] 薛章委, 方文旭, 陈文质,等. 完整保留悬雍垂及软腭游离缘手术治疗阻塞性睡眠呼吸暂停低通气综合征的疗效评价[J]. 吉林大学学报(医学版),2012,38(1):147-150.
[8] 龚为群, 阎萍. 杨世权,等. Epworth嗜睡量表联合匹兹堡睡眠质量指数量表在不同程度鼻源性OSAHS患者中的临床应用[J]. 重庆医学,2016,45(32):4549-4551.
[9] Fujita S, Conway W, Zorick F, et al. Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty[J]. Otolaryngol Head Neck Surg, 1981,89(6):923-934.
[10] 黄丽华, 余勤. 阻塞性睡眠呼吸暂停低通气综合征最新治疗进展[J]. 兰州大学学报(医学版),2021,47(3):98-101.
[11] Hasselbacher K, Seitz A, Abrams N, et al. Complete concentric collapse at the soft palate in sleep endoscopy: what change is possible after UPPP in patients with CPAP failure? [J]. Sleep Breath, 2018,22(4):933-938.
[12] 袁伟, 孙建军, 李进让,等.腭帆成形术治疗Ⅱ型OSAHS的综合性疗效评价[J].解放军医学杂志,2015,40(10):837-840.
[13] Camacho M, Certal V, Modi R, et al. Tissue-sparing uvulopalatopharyngoplasty for OSA: conservative, compassionate and possibly just as effective[J]. Indian J Otolaryngol Head Neck Surg, 2019,71(1):5-6.
[14] 倪炳华. 阻塞性睡眠呼吸暂停综合征患者手术前后腭咽测量及临床意义[J]. 中国临床解剖学杂志,2000,18(4): 349-350.
[15] Mcginley BM, Schwartz AR, Schneider H, et al. Upper airway neuromuscular compensation during sleep is defective in obstructive sleep apnea[J]. J Appl Physiol (1985), 2008,105(1):197-205.
[16] Lofsson K, Mattsson C, Hammarstrom ML, et al. Structure of the human uvula[J]. Acta Otolaryngol, 1999,119(6): 712-717.
[17] Ritter CT , Trudo FJ , Goldberg AN , et al. Quantitative evaluation of the upper airway changes in normals and apneics during Müller maneuver[J]. The American review of respiratory disease, 1998, 157:A54.
[18] 银兴贵. 悬雍垂腭咽成形术联合同期鼻腔扩容术治疗阻塞性睡眠呼吸暂停低通气综合征的临床观察[J]. 中国药物与临床,2021,21(7):1122-1124.
[19] 刘鸿源, 宋志耘, 王健. 鼾症及其外科治疗(附121例报告)[J]. 天津医药,1989,17(9):529-531.
[20] 孙建军, 李进让. 阻塞性睡眠呼吸暂停综合征的外科治疗:腭帆成型与口咽气道扩大[J]. 解放军医学杂志,2002,27(2):168-169.
[21] 王希, 郭春丽, 石冰, 等. 先天性腭咽闭合不全的腭咽闭合状态及语音特点分析[J]. 华西口腔医学杂志,2020,38(6):662-666.
[22] Hsu PP, Hanh NC, Chan YH, et al. Quantitative computer-assisted digital-imaging upper airway analysis for obstructive sleep apnoea[J]. Clin Otolaryngol Allied, 2010,29(5):522-529.
[23] 雷奕优, 娄卫华, 张会霞, 等. 阻塞性睡眠呼吸暂停低通气综合征患者软腭形态的动态磁共振研究[J]. 听力学及言语疾病杂志,2018,26(4): 405-408.
[24] 赵圆, 杨婷, 彭文涛, 等. 下颌前移矫治器治疗阻塞性睡眠呼吸暂停低通气综合征的研究进展[J]. 国际口腔医学杂志, 2020, 47(3): 328-335.
[25] 刘洋, 杨相立, 刘吉祥, 等. 睡眠监测阻塞定位仪在阻塞性睡眠呼吸暂停低通气综合征阻塞部位分析中的应用价值[J]. 医疗装备,2021,34(5): 5-7.
