喉罩辅助改良气管切开术在重症OSAHS多平面手术治疗中的应用

目的：探讨喉罩辅助改良气管切开术在重症阻塞性睡眠呼吸暂停低通气综合征（OSAHS）多平面手术中的应用价值。方法回顾性分析我科近5年在喉罩辅助改良气管切开术条件下对重症OSAHS实施同期行多平面手术的21例患者临床资料。首先经口插入喉罩行全麻，继行横切口改良气管切开术，术毕拔出喉罩，通过气管造口插管维持全麻，再完成多平面OSAHS手术。结果本组患者术毕均未进ICU复苏而直接返回普通病房，无明显手术相关并发症；气管套管拔管时间为7～30天。随诊6个月，手术效果满意。结论喉罩辅助改良气管切开术易行而并发症少，切口瘢痕不明显，为同期行多平面手术治疗重症OSAHS的患者提供了安全保障。

Application of modified tracheotomy assisted by laryngeal mask in the multi-plane surgery for severe obstructive sleep apnea hypopnea syndrome

Objective To explore the clinical value of modified tracheotomy assisted by laryngeal mask in the multi-plane surgery under general anesthesia for patients with severe obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods A retrospective review was made among 21 cases with severe OSAHS treated by a concurrent multi-plane surgery under the condition of modified tracheotomy assisted by laryngeal mask with general anesthesia, performed during recent 5 years, with their clinical data reviewed carefully. General anesthesia was carried out by inserting laryngeal mask through mouth at first, and then, modified tracheotomy was performed via a transverse incision, followed by pulling out laryngeal mask and inserting endotracheal tube through tracheal stoma. After this procedure, a multiple plane operation was done under such a condition to treat severe OSAHS concurrently. Results All these patients were sent back to the general ward instead of ICU after the operation, with no major operation-associated complications occurred during the period of hospital stay. Tracheal tube was pulled out successfully among these cases within 7 to 30 days. By the end of following up period lasted for 6 months, all patients were satisfied with their surgery and rehabilitation efficacy. Conclusions Modified tracheotomy assisted by laryngeal mask is easy to perform, with few complications occurring and inconspicuous postoperative scar in the region of incision. Such a procedure may ensure the concurrent multi-plane operation on cases with severe OSAHS performed safely as possible as it can.