A comparative study on treatment of severe OSA with UPPP combined with endoscopic low-temperature plasma tongue root resection
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摘要: 目的 探讨改良悬雍垂腭咽成形术(H-UPPP)联合内镜下低温等离子舌根切除术(Eco-TBR)治疗重度OSA的疗效。方法 经多导睡眠监测确诊的60例重度OSA患者，其阻塞平面为口咽和舌根部，根据患者入院顺序随机分为对照组和试验组，对照组30例行单纯H-UPPP，试验组30例行H-UPPP联合Eco-TBR。应用SPSS 20.0软件包进行2组术前、术后相关数据分析。结果 57例患者完成了术前、术后主观和客观资料的随访，时间至少6个月。术后对照组治疗总有效率(41.38%)低于试验组的总有效率(67.85%)，差异有统计学意义(χ2=4.03，P < 0.05)。术后对照组AHI为28.07±10.283，LSaO2为72.66±6.405，ESS为12.62±2.731、snoring VAS为3.93±1.307；术后试验组AHI为25.74±14.140，LSaO2为75.36±7.299，ESS为11.32±3.209、snoring VAS为3.00±1.305。2组术后与术前AHI、LSaO2、ESS、snoring VAS分别比较差异均有统计学意义(P < 0.001)。对照组和试验组术后AHI、LSaO2、ESS、snoring VAS分别比较，除snoring VAS外，差异无统计学意义(P>0.05)。结论 H-UPPP联合Eco-TBR治疗以口咽和舌根为阻塞平面的重度OSA患者的疗效确切。
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关键词:
- 睡眠呼吸暂停，阻塞性 /
- 改良腭咽成形术 /
- 舌根手术 /
- 消融技术
Abstract: Objective The aim of this study is to investigate the effect of modified uvulopalatopharyngoplasty (UPPP) combined with endoscopic hypothermic Plasma glossectomy (Eco-TBR) on the severe Obstructive sleep apnea syndrome.Method Sixty patients with severe OSAHS were diagnosed by polysomnography, and their obstructive plane located in the oropharynx and tongue base. Patients were divided into the control group (30 cases of simple H-UPPP) and the experimental group (30 cases of H-UPPP combined with Eco-TBR) according to their random hospital sequence. SPSS 20.0 software package was used to analyze the preoperative and postoperative data of the two groups.Result Fifty-seven OSAHS patients had full data and a minimum 6 month follow up to assess the efficacy. The total effective rate in the control group was 41.38% lower than that in the experimental group 67.85%, and the difference was statistically significant (χ2=4.03, P < 0.05). The postoperative data of the control group, AHI was 28.07±10.283, LSaO2 was 72.660±6.405, ESS was 12.620±2.731, and snoring VAS were 3.93±1.307. After the operation, in the experimental group, AHI was 25.74±14.140, LSaO2 was 75.360±7.299, ESS was 11.320±3.209, and snoring VAS were 3.00±1.305. The differences in AHI, LSaO2, ESS and snoring VAS before and after surgery in the two groups were statistically significant (P < 0.001). After surgery, compared between the two groups, except for snoring VAS, the differences of AHI, LSaO2 and ESS were not statistically significant(P>0.05).Conclusion The effect of H-UPPP combined with Eco-TBR on severe OSAHS patients with obstructive plane of oropharynx and tongue root is definite. -
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表 1 对照组与试验组手术前后及术后AHI、LSaO2、ESS、snoring VAS比较
x±s 参数 对照组(29例) 试验组(28例) t1 P1 t2 P2 t3 P3 术前 术后 术前 术后 AHI 51.67±13.135 28.07±10.283 53.24±14.166 25.74±14.140 7.618 P < 0.01 7.270 P < 0.01 0.715 >0.05 LSaO2 59.90±4.143 72.66±6.405 60.18±3.840 75.36±7.299 -9.007 P < 0.01 -9.739 P < 0.01 -1.487 >0.05 ESS 19.72±3.138 12.62±2.731 19.43±3.490 11.32±3.209 9.195 P < 0.01 9.048 P < 0.01 1.648 >0.05 snoring VAS 8.72±1.222 3.93±1.307 8.79±1.258 3.00±1.305 14.425 P < 0.01 16.890 P < 0.01 2.690 < 0.05 注：t1、P1为对照组参数术前、术后比较；t2、P2为试验组参数术前、术后比较；t3、P3为对照组术后参数与试验组术后参数比较。 
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表 2 AHI较术前增高2例患者术前和术后AHI、LSaO2、ESS、snoring VAS比较
例序 性别 年龄 BMI AHI LSaO2 ESS snoring VAS 术前 术后 术前 术后 术前 术后 术前 术后 术前 术后 1 男 36 27.8 27.5 58.8 59.9 60 62 21 18 9 3 2 男 38 28.3 27.9 50.5 51.7 59 68 20 15 9 5
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