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目的 :评估腭垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)术前、术后第3天及1、2、3、6个月时上气道及舌骨位置的变化速率,验证UPPP术后短期上气道重塑的现象。方法:选择2013年11月—2014年9月期间于上海交通大学医学院附属第九人民医院就诊并接受UPPP术的21例成年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者(平均年龄36.58±3.47岁),术前、术后第3天及1、2、3、6个月时拍摄头颅定位侧位片及“i”音位片。通过AUTOCAD2015测量,得到各时间点的上气道不同区域(鼻咽、腭咽、舌咽及喉咽气道)前后径及舌骨位置参数(垂直向与水平向),利用SAS 8.02软件包比较各参数之间的差异,分析评估UPPP术后短期上气道的重塑现象。结果:UPPP术的创伤主要影响腭咽及舌咽气道,腭咽及舌咽参数缩小(P<0.05),同时UPPP可导致舌骨位置向后下移位(P<0.05)。UPPP术后上气道及舌骨位置参数持续改变,鼻咽气道在术后1~6个月无显著变化(P>0.05),腭咽气道前后径在术后持续增加(P<0.05),舌咽气道前后径在术后1月显著增加(P<0.05)。喉咽气道前后径在术后2~6个月逐步减小(P<0.05),舌骨位置总体向后下下降(P<0.05),但在术后1个月内舌骨位置处于上升状态(P<0.05)。结论:UPPP术后6个月内上气道存在重塑现象。
OBJECTIVE: To evaluate the rate of change of upper airway and hyoid bone position before, 3 and 1, 2, 3 and 6 months after uvulopalatopharyngoplasty (UPPP) Airway remodeling phenomenon. METHODS: Twenty-one patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) who underwent UPPP at Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine from November 2013 to September 2014 (mean age 36.58 ± 3.47 years old), preoperative and postoperative 3 days and 1, 2, 3, 6 months when shooting the cranial positioning flaps and “i ” phoneme. By AUTOCAD2015 measurement, the anteroposterior diameter and hyoid position parameters (vertical and horizontal) of different upper airway regions (nasopharynx, velopharyngeal, glossopharyngeal and hypopharyngeal airway) at various time points were obtained. SAS 8.02 software package was used to compare The differences between the parameters were analyzed to assess the short-term airway remodeling after UPPP. Results: The wounds of UPPP mainly affected the velopharyngeal and glossopharyngeal airway, the parameters of velopharyngeal and glossopharyngeal were reduced (P <0.05), and UPPP could cause the position of hyoid bone downward shift (P <0.05). The parameters of upper airway and hyoid bone continued to change after UPPP, the nasopharyngeal airway did not change significantly from 1 month to 6 months after operation (P> 0.05), and the anteroposterior diameter of velopharyngeal airway continued to increase after operation (P <0.05) Tongue and pharyngeal airway anteroposterior diameter in January after a significant increase (P <0.05). The anteroposterior diameter of laryngopharyngeal airway gradually decreased from 2 to 6 months after operation (P <0.05), and the position of hyoid bone decreased backwards and downwards (P <0.05). However, within 1 month after operation, the position of hyoid bone was rising (P <0.05). Conclusion: There is remodeling of the upper airway within 6 months after UPPP.