循证医学与悬雍垂腭咽成形术术式的演变

目的:应用循证医学指导悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)术式的演变。材料与方法:1989年1月1日至2000年12月31日我科共实施UPPP124例,其中男性119例,女性5例,年龄26-62岁,平均41.33岁;呼吸紊乱指数5.22-136.02,平均41.75;最低血氧饱和度33-88%,平均68.23%。术式演变过程分以下三个阶段。①1989年至1999年6月共对61例阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者进行了传统的UPPP;②1999年7月至2000年3月共对28例OSAS患者进行了CO2激光辅助的重建悬雍垂的UPPP;⑧2000年4月至2000年12月,共对35例OSAS患者进行了CO2激光辅助的保留悬雍垂全长的UPPP。结果:各种术式术后1年随访,患者打鼾、白天嗜睡等症状得到不同程度的缓解。但传统的UPPP后,多数患者术后短期内出现进食时食物鼻腔返流,咽部失去软腭的正常形态,而呈“⌒”形,对患者造成了一定的心理影响。而重建悬雍垂的UPPP后复查发现,所重建的悬雍垂并没有保持形态,而逐渐萎缩,仅剩一小的突起,咽部仍失去软腭的正常形态,并没有达到预期效果。保留悬雍垂全长的UPPP,患者术后未出现进食时食物鼻腔返流,术后1年复查,咽部仍保持软腭的正常形态,悬雍垂形态、大小基本同术前,甚至较术前有所缩小,达到了预期效果。结论:

Evidence based medicine and the evaluation of uvulopalatopharyngoplasty

Objective: To guidance the evaluation of uvulopalatopharyngoplasty (UPPP)using the theory of evidence based medicine. Methods: One hundred and twenty four patients with obstructive sleep apnea syndrome (OSAS)were treated by the surgery of UPPP from January 1989 to December 2000. All patients were diagnosed by polysomnography (PSG).There were 119 males and 5 females, ranging in age from 26 to 62 years old (mean age was 41.33).The respiratory disturbance index (RDI)was 5.22 to 136.02(mean 41.75).The minimum oxygen saturation was 33% to 81% (mean 68. 23%). Patients were divided three groups. The group A was 61 cases,which treated by the procedure of traditional UPPP from January 1989 to June 1996. The group B was 28,which by the procedure of CO2 laser assisted UPPP with reconstruction of uvula from July 1997 to March 2000. The group C was 35 cases,which by the procedure of CO2 laser assisted UPPP with the conservation of uvula from April 2000 to December 2000. Results;All of the symptoms of patients such as snoring ,lethargy,were alleviated in different degrees after follow up for one year. The conditions of postoperative nasal reflux were fund in patients of group A and group B. And the uvula also did not get a normal form of soft palate after follow up 1 year in patients of group B. The procedure of CO2 laser assisted UPPP with the conservation of uvula got a normal form of soft palate and avoided the postoperative nasal reflux. Conclusion:After several revisions,the procedure of CO2 laser assisted UPPP with the conservation of uvula achieve the aim of conservation the normal form of soft palate and avoiding the nasal reflux.