摘要
目的对肥胖伴OSAHS患者,手术可能造成颅颌面形态异常,为获得理想双颌前移后颅颌面形态,进行计算机辅助设计、模拟的定量手术研究。方法(1)采用自行建立的上呼吸道测量、分析系统,进行阻塞部位和程度检查;同时摄发/i/音时的头颅定位侧位片,测量腭咽闭合点,按一定比例切除多余的软腭。(2)采用计算机手术模拟系统,对肥胖伴严重OSAHS患者进行手术模拟,以在双颌足够前移的前提下保证患者有一个美观的颅颌面外形。34例患者接受术前和术后PSG监测和头影测量分析及语音评价。结果手术成功率为85.29%,29例患者术后睡眠呼吸暂停-低通气指数降低50%以上或降至20%以下,睡眠质量和睡眠低氧状态得到显著改善。头影测量分析显示:34例患者腭咽闭合功能良好;语音检测显示:患者手术前后语音功能无显著差异(P>0.05)。结论不同阻塞部位、程度的患者,需要不同的手术方式或组合。UPPP手术成功的关键在于:严格掌握手术适应证,精确计算软腭切除量。计算机辅助的定量UPPP显著提高了手术成功率。对于肥胖伴严重OSAHS患者进行双颌前移手术治疗时,在保证颌骨足够前移的同时,需注意颅面形态的变化。
Objective To enhance the efficiency of UPPP and to obtain ideal post operative profile of obese patients with severe OSAHS, as well as to reduce the surgical complications. Methods The craniomaxillofacial profile and upper airway space and dimension of the patients were evaluated by using our computer-aided cephalometric analysis system. The patients were asked to sound continuously /i/ and radiography was taken to find the palatopharyngeal closure point, the distance from the point to the top of uvula were measured to determine how to cut the soft palate. The surgical procedure was gained using computer-aided simulated system to enlarge upper airway enough and obtain a good post operative profile. The post operative results of PSG, cephalometric analysis and evaluation of speech were compared with those preoperatively. Results 85.29% patients had a good response to the procedure. Their sleep-related breathing disorders were relieved and there were no significant differences in all patients' speech pre- and post-operatively. Conclusions The quantity of removal of soft palate when performing UPPP is the key for success, and it is clear that UPPP only relieved the obstruction in the level of oropharynx. It should pay attention to the surgical procedure for the oriental obese patients with severe OSAHS that need bi-maxillary advancement.
出处
《中国口腔颌面外科杂志》
CAS
2003年第4期200-204,共5页
China Journal of Oral and Maxillofacial Surgery
