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目的探讨应用改良的悬雍垂腭咽成形术(H-UPPP)配合软腭、舌体低温等离子消融治疗腭-咽平面、舌-咽平面阻塞所致的重度阻塞性睡眠呼吸暂停低通气综合征的可行性、优越性和注意事项。方法对30例经多导睡眠监测,Muller动作检测确定的因腭-咽平面、舌-咽平面阻塞所致的重度阻塞性睡眠呼吸暂停低通气综合征患者进行了改良的悬雍垂腭咽成形术(H-UPPP)配合软腭、舌体低温等离子消融,术中完整保留悬雍垂,切除腭帆间隙脂肪组织,扩大软腭成形范围,并于软腭及舌体低温等离子打孔消融,全部患者均分别进行了术前和术后6个月、1年、3年多导睡眠监测。结果按照杭州会议疗效评定标准,6月内有效率100.00%,1年有效率83.33%,3年有效率76.67%,无1例术中或术后行气管切开术,无1例出现软腭粘连、鼻咽狭窄、大出血、开放性鼻音、死亡。结论对腭-咽平面、舌-咽平面阻塞所致的重度阻塞性睡眠呼吸暂停低通气综合征的患者,软腭、舌体低温等离子消融配合H-UPPP治疗是安全、有效的,具有简单、微创,无需气管切开,愈合快等优点,同时应注意术前应用CPAP治疗,全麻清醒后24 h才拔出气管插管。
Objective To investigate the therapeutic effects of modified uvulopalatopharyngoplasty (H-UPPP) combined with soft palate and low-temperature plasma ablation of the tongue on the treatment of severe obstructive sleep apnea-hypopnea syndrome Feasibility, Advantages and Precautions. Methods Thirty patients with severe obstructive sleep apnea-hypopnea syndrome (COPD) due to obstruction of palate - pharyngeal plane and tongue - pharyngeal obstruction confirmed by polysomnography and Muller ’s motions were treated with modified uvulopalatopharyngoplasty (H-UPPP) with soft palate, tongue low-temperature plasma ablation, intraoperative preservation of uvula complete removal of palatal fissure clearance of fat tissue to expand the range of soft palate and soft palate and tongue low temperature plasma drilling ablation, all patients Preoperative and postoperative 6 months, 1 year, 3 years polysomnography monitoring. Results According to the evaluation standard of Hangzhou meeting, the effective rate was 100.00% in June, 83.3% in one year, and 76.67% in three years. There was no tracheotomy in operation or postoperatively. No case of soft palate adhesion , Nasopharyngeal stenosis, bleeding, open nasal, death. Conclusions For patients with severe obstructive sleep apnea-hypopnea syndrome due to obstruction of pharynx and pharynx-pharyngeal plane, low-temperature plasma ablation of soft palate and tongue with H-UPPP is safe and effective. Create, without tracheostomy, healing and other advantages, and should pay attention to preoperative CPAP treatment, 24 h after anesthesia awake only pull out tracheal intubation.