腭帆成形技术对Ⅱ型阻塞性睡眠呼吸暂停低通气综合征患者咽腔重塑作用与相关解剖研究

目的 对一种新的腭帆成形技术(velopharyngoplasty,VPP)进行解剖学特征研究,探讨该术式对咽腔重塑的作用机制.方法 对2个成人男性尸头进行软腭解剖,建立VPP手术标本,观察其技术特征.85例经PSG确诊阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者施行腭帆成形术,并进行随访;选取其中10例患者进行术前、术后(6-11个月)的腭咽CT,利用CT工作站对腭咽腔多种解剖学标志进行影像学测量.结果 腭咽腔各项测量参数包括:软腭长、软腭最大厚度、软腭游离缘至咽后壁间距、咽侧间距(扁桃体间距)、悬雍垂长度、悬雍垂基部宽度、腭咽截面积、咽峡截面积,手术前后各测量值差异均有统计学意义(37.8±5.5)mm vs(27.0±4.1)mm,(13.3±2.2)mm vs(9.3±2.5)mm,(7.1±2.8)mm vs(10.3±1.7)mm,(45.2±25.5)mm~2 vs(135.3±26.4)mm~2,(2.0±21.8)mm~2 vs(208.4±15.9)mm~2];咽后壁厚度手术前后差异无统计学意义(6.8±2.9)mm vs(7.0±2.5)mm].结论 VPP通过切口设计、咽腭弓、扁桃体切除及咽侧黏膜切除与缝合处理,能够解除腭咽部位的阻塞,实现重塑腭咽腔的目的 .此术式可达到明显提升腭帆、前移悬雍垂、扩大口咽气道的目的 ;是一种有意义的外科技术.

Role of remodeling of pharyngeal cavity in velopharyngoplasty for treating obstructive sleep apnea hypopnea syndrome and its related anatomic study

Objective To investigate a new velopharyngoplasty (VPP), including its anatomic character and its mechanism of remodeling of oral-pharynx cavity for treating obstructive sleep apnea hypopnea syndrome ( OSAHS). Methods Two cases of soft palate were dissected in adult male cadavers. And the model of VPP was established to further observe its technical characteristics. A total of 85 OSAHS patients were studied by PSG. And all cases received velopharyngoplasty (VPP) and follow-ups. Ten cases were selected for CT scanning of palatal pharyngeal cavity and CT workstation was employed for imaging measurements. Results The measured parameters of pharyngeal palate included soft palate length, maximal thickness of soft palate, soft palate to posterior pharyngeal edge of free space, parapharyngeal space (distance between tonsils) , uvula length, width of uvula base, velopharyngeal cross-sectional area and cross-sectional area of angina. All these parameters had a significantly difference between pre-operation and post-operation (37. 8±5.5)mm vs (27.0 ±4. 1)mm,( 13. 3 ±2. 2) mm vs (9. 3 ±2. 5) mm, (7. 1 ±2. 8) mm vs (10. 3 ± 1.7)mm,(45.2±25.5)mm~2 vs (135. 3 ±26.4)mm~2,(2. 0 ±21. 8)mm~2 vs (208.4 ± 15. 9)mm~2]; however there was no significant difference in retropharyngeal wall thickness(6. 8 ±2. 9)mm vs (7.0 ±2. 5) mm]. Conclusion VPP remodels palatopharyngeal region through the design of incision, the management of pharyngopalatine arch tonsillectomy and the suture of laterapharynx mucisae. This surgical procedure can obviously upgrade the velum palatinum, enlarge the oropharyngeal airway effectively. It is a significant modified-UPPP surgical technique.