腭帆成形术治疗中重度Ⅱ型OSAHS的疗效分析与相关解剖学研究
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摘要
目的在软腭解剖学的基础上，建立腭帆成形术手术(VPP)模型，并收集OSAHS患者手术前、后腭咽腔形态学变化，总结其技术特点。通过术中腭咽腔测量及系统的腭咽腔CT测量，探讨其手术机理。
方法30例经PSG确诊OSAHS患者施行腭帆成形术，进行术中腭咽腔测量，测量项目包括：软腭长度、悬雍垂长度及基部宽度、咽侧间距(腭扁桃体间距)。随机对10例患者进行系统的腭咽CT测量，测量时间为术前、术后3个月、术后6个月；测量方法为：患者在清醒状态下进行平静呼吸时的上气道CT扫描，范围自听眶线至声门。利用CT工作站进行三维重建和测量。CT扫描时患者取仰卧位，牙齿处于正中颌的接触位上。扫描过程中保持头部和身体静止，勿吞咽；测量指标：包括软腭长度、软腭最大厚度、悬雍垂长度及基部宽度、咽侧间距(腭扁桃体间距)、咽后壁厚度、软腭游离缘至咽喉壁间距、腭咽截面积、咽峡截面积。所有患者随访6-12个月，详细询问术后反应，填写ESS表，测量并记录颈围及BMI，口咽拍照，CT扫描；进行PSG复查，按照2002杭州标准进行疗效评定，总结VPP近期疗效，对其手术机理、疗效影响因素进行统计学分析。
结果30例OSAHS患者均顺利完成手术，术后可出现短暂的腭咽关闭不全，持续时间为1-2周；出现短暂的急性咽喉痛，持续时间为1-2周；8例患者出现咽部异物感。继发性出血2例，1例为软腭游离缘，1例为扁桃体下极，经电凝止血痊愈。无咽腔瘢痕狭窄、开放性鼻音、误咽等并发症。30例OSAHS患者术中腭咽测量各项指标(软腭长度、悬雍垂长度及基部宽度、咽侧间距(腭扁桃体间距))手术前后均有统计学差异；10例OSAHS患者通过系统的腭咽CT测量，发现口咽形态学改变主要体现在术前和术后12周，各项指标(软腭长、软腭最大厚度、咽侧间距(扁桃体间距)、悬雍垂长度及基部宽度、软腭游离缘至咽喉壁间距、腭咽截面积、咽峡截面积)均有统计学差异；咽后壁厚度无统计学差异。AHI由术前54.6±18.3降至术后25.3±9.5，ESS评分由术前16.5±4.8降至术后5.2±4.1近期有效率为70.0％。
结论VPP技术通过切口设计、腭咽弓、扁桃体切除及咽侧粘膜切除与缝合处理，实现腭咽腔软组织的重塑，有效的解除了腭咽腔的阻塞。此术式可达到明显提升腭帆、前移悬雍垂与软腭游离缘、扩大口咽气道的目的；是一种有实用价值的上气道外科技术。
Obojective Based on the homologic anatomy study of soft palate, establishthe model of velopharyngoplasty(VPP), and collect OSAHS patientspreoperation and postoperation pharynx morphological changes, summing upits technical characteristics; explore the mechanism of VPP mechnism by themeasurement of velopharyngeal cavity during operation and that of system CTmeasurement.
Methods 30 OSAHS patients diagnosed by PSG were included in this study,all cases had velopharyngoplasty(VPP).All had measured the velopharyngealcavity including: length of the soft palate, uvula length and width of the base,parapharyngeal space (distance between the tonsils).10 cases of patients hadthe measurement of velopharyngeal CT, with the time for patients beforeoperation, after the operation of three and six months; measurement methodas follows: patients were in awake quiet breathing, the scope of the upperairway CT scan from the orbital line to the glottis, further using CTworkstation to three-dimensional reconstruct and measure.During CT scan,patients were in supine position, and the teeth in the middle of the contactposition on the jaw; and maintain a static head and body during the scanningprocess, did not swallow; measurement parameters including: soft palatelength, maximum thickness of the soft palate, pharynx lateral spacing (distance between the tonsils), uvula length and base width of the free edge ofsoft palate to the throat wall spacing, velopharyngeal cross-sectional area,angina cross-sectional area,thickness of retropharyngeal wall.All the patientshad follow up for 6-11 months, filled out the ESS table, measuring the neckcircumference and BMI, oropharyngeal photographs, CT scans; for PSGreview, in accordance with the 2002 standards for efficacy assessment ofHangzhou, summarized VPP efficacy, its surgerical mechanism and theimpact of factors.
Results 30 cases of OSAHS patients had successful VPP, all with short-termpostoperative velopharyngeal insufficiency, duration of 1 -5 weeks; allshort-term acute throat pain, duration of 1-4 weeks; 8 patients pharyngealforeign body sensation, considered 3 cases complicating with hypopharyngealreflux disease, five cases with unexplained reasons by specialist examination;2 patients had secondary hemorrhage, 1 case for the free edge of soft palate, 1case of tonsil pole cured by electrocoagulation, no pharyngeal scar narrow,open nasal, complications such as aspiration.30 cases had a significantdifference before and after surgery in the measurement ofvelopharyngeal,incluing: soft palate length, base of uvula length and width oflateral pharyngeal space (tonsil spacing); 10 cases had found that themorphological changes of oropharyngeal had a significant difference mainly in preoperative and postoperative 12 weeks, all the measurement ofvelopharyngeal, incluing: soft palate length, maximum thickness of the softpalate, pharynx lateral spacing (distance between the tonsils), uvula length andbase width of the free edge of soft palate to distance between the throat wall,velopharyngeal cross-sectional area,and angina cross-sectional area;however,there was no significant difference in retropharyngeal wall thickness.Apnea and hypopnea index(AHI)were decreased from 54.6±18.3preoperatively to 25.3±9.5 postoperatively, ESS score from 16.5±4.8preoperatively to 5.2±4.1 postoperatively.The recent rate of VPP was70.0%.
Conclusion Velopharyngoplasty(VPP) remodeled palatopharyngeal districtand relieved the obstruction of palatal pharyngeal through the designing ofincision,the management of pharyngopalatine arch, tonsillectomy and thesuture of laterapharynx mucisae.This surgerical procedure could obviouslyupgrade the velum palatinum,enlarge the oropharynx airway effectively,andwas a parctical upper airway surgical technique.
方法30例经PSG确诊OSAHS患者施行腭帆成形术，进行术中腭咽腔测量，测量项目包括：软腭长度、悬雍垂长度及基部宽度、咽侧间距(腭扁桃体间距)。随机对10例患者进行系统的腭咽CT测量，测量时间为术前、术后3个月、术后6个月；测量方法为：患者在清醒状态下进行平静呼吸时的上气道CT扫描，范围自听眶线至声门。利用CT工作站进行三维重建和测量。CT扫描时患者取仰卧位，牙齿处于正中颌的接触位上。扫描过程中保持头部和身体静止，勿吞咽；测量指标：包括软腭长度、软腭最大厚度、悬雍垂长度及基部宽度、咽侧间距(腭扁桃体间距)、咽后壁厚度、软腭游离缘至咽喉壁间距、腭咽截面积、咽峡截面积。所有患者随访6-12个月，详细询问术后反应，填写ESS表，测量并记录颈围及BMI，口咽拍照，CT扫描；进行PSG复查，按照2002杭州标准进行疗效评定，总结VPP近期疗效，对其手术机理、疗效影响因素进行统计学分析。
结果30例OSAHS患者均顺利完成手术，术后可出现短暂的腭咽关闭不全，持续时间为1-2周；出现短暂的急性咽喉痛，持续时间为1-2周；8例患者出现咽部异物感。继发性出血2例，1例为软腭游离缘，1例为扁桃体下极，经电凝止血痊愈。无咽腔瘢痕狭窄、开放性鼻音、误咽等并发症。30例OSAHS患者术中腭咽测量各项指标(软腭长度、悬雍垂长度及基部宽度、咽侧间距(腭扁桃体间距))手术前后均有统计学差异；10例OSAHS患者通过系统的腭咽CT测量，发现口咽形态学改变主要体现在术前和术后12周，各项指标(软腭长、软腭最大厚度、咽侧间距(扁桃体间距)、悬雍垂长度及基部宽度、软腭游离缘至咽喉壁间距、腭咽截面积、咽峡截面积)均有统计学差异；咽后壁厚度无统计学差异。AHI由术前54.6±18.3降至术后25.3±9.5，ESS评分由术前16.5±4.8降至术后5.2±4.1近期有效率为70.0％。
结论VPP技术通过切口设计、腭咽弓、扁桃体切除及咽侧粘膜切除与缝合处理，实现腭咽腔软组织的重塑，有效的解除了腭咽腔的阻塞。此术式可达到明显提升腭帆、前移悬雍垂与软腭游离缘、扩大口咽气道的目的；是一种有实用价值的上气道外科技术。
Obojective Based on the homologic anatomy study of soft palate, establishthe model of velopharyngoplasty(VPP), and collect OSAHS patientspreoperation and postoperation pharynx morphological changes, summing upits technical characteristics; explore the mechanism of VPP mechnism by themeasurement of velopharyngeal cavity during operation and that of system CTmeasurement.
Methods 30 OSAHS patients diagnosed by PSG were included in this study,all cases had velopharyngoplasty(VPP).All had measured the velopharyngealcavity including: length of the soft palate, uvula length and width of the base,parapharyngeal space (distance between the tonsils).10 cases of patients hadthe measurement of velopharyngeal CT, with the time for patients beforeoperation, after the operation of three and six months; measurement methodas follows: patients were in awake quiet breathing, the scope of the upperairway CT scan from the orbital line to the glottis, further using CTworkstation to three-dimensional reconstruct and measure.During CT scan,patients were in supine position, and the teeth in the middle of the contactposition on the jaw; and maintain a static head and body during the scanningprocess, did not swallow; measurement parameters including: soft palatelength, maximum thickness of the soft palate, pharynx lateral spacing (distance between the tonsils), uvula length and base width of the free edge ofsoft palate to the throat wall spacing, velopharyngeal cross-sectional area,angina cross-sectional area,thickness of retropharyngeal wall.All the patientshad follow up for 6-11 months, filled out the ESS table, measuring the neckcircumference and BMI, oropharyngeal photographs, CT scans; for PSGreview, in accordance with the 2002 standards for efficacy assessment ofHangzhou, summarized VPP efficacy, its surgerical mechanism and theimpact of factors.
Results 30 cases of OSAHS patients had successful VPP, all with short-termpostoperative velopharyngeal insufficiency, duration of 1 -5 weeks; allshort-term acute throat pain, duration of 1-4 weeks; 8 patients pharyngealforeign body sensation, considered 3 cases complicating with hypopharyngealreflux disease, five cases with unexplained reasons by specialist examination;2 patients had secondary hemorrhage, 1 case for the free edge of soft palate, 1case of tonsil pole cured by electrocoagulation, no pharyngeal scar narrow,open nasal, complications such as aspiration.30 cases had a significantdifference before and after surgery in the measurement ofvelopharyngeal,incluing: soft palate length, base of uvula length and width oflateral pharyngeal space (tonsil spacing); 10 cases had found that themorphological changes of oropharyngeal had a significant difference mainly in preoperative and postoperative 12 weeks, all the measurement ofvelopharyngeal, incluing: soft palate length, maximum thickness of the softpalate, pharynx lateral spacing (distance between the tonsils), uvula length andbase width of the free edge of soft palate to distance between the throat wall,velopharyngeal cross-sectional area,and angina cross-sectional area;however,there was no significant difference in retropharyngeal wall thickness.Apnea and hypopnea index(AHI)were decreased from 54.6±18.3preoperatively to 25.3±9.5 postoperatively, ESS score from 16.5±4.8preoperatively to 5.2±4.1 postoperatively.The recent rate of VPP was70.0%.
Conclusion Velopharyngoplasty(VPP) remodeled palatopharyngeal districtand relieved the obstruction of palatal pharyngeal through the designing ofincision,the management of pharyngopalatine arch, tonsillectomy and thesuture of laterapharynx mucisae.This surgerical procedure could obviouslyupgrade the velum palatinum,enlarge the oropharynx airway effectively,andwas a parctical upper airway surgical technique.
引文
1. Fujita S , Conway W, Zorick F et al . Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome : vulopalatopharyngoplasty [J] .Otolaryngol Head Neck Surg, 1981, 89(6): 923-934.
2. Elasfour A, Miyazaki S, Itasaka Y , et al Evaluation of uvulopalatopharyngoplasty in treatment of obstructive sleep apnea syndrome [J]. Acta Otolaryngol Suppl, 1998,537 : 52-56.
3．孙建军 李进让．阻塞性睡眠呼吸暂停综合征的外科治疗-腭帆成型与口咽气道扩大[J]．解放军医学杂志．2002，27(2)：168-169．
4．中华医学会耳鼻咽喉科学分会 中华耳鼻咽喉科杂志编委会．阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准暨悬雍垂腭咽成形术适应证(杭州)．中华耳鼻咽喉科杂志，2002，37(6：)403-404．
1. Fujita S , Conway W, Zorick F et al. Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome uvulopalatopharyngoplasty [J]. Otolaryngol Head Neck Surg, 1981, 89(6): 923-934.
2. Elasfour A, Miyazaki S, Itasaka Y , et al Evaluation of uvulopalatopharyngoplasty in treatment of obstructive sleep apnea syndrome [J]. Acta Otolaryngol Suppl, 1998,537: 52-56.
3．孙建军 李进让．阻塞性睡眠呼吸暂停综合征的外科治疗-腭帆成型与口咽气道扩大[J]．解放军医学杂志．2002，27(2)：168-169．
4．中华医学会耳鼻咽喉科学分会 中华耳鼻咽喉科杂志编委会．阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定 标准暨悬雍垂腭咽成形术适应证(杭州)．中华耳鼻咽喉科杂志，2002，37(6)：403-404．
5．刘文君 曹文强 葛瑞峰 等．阻塞性睡眠呼吸暂停综合征患者咽腔形态学测量[J]．中华耳鼻咽喉科杂志，1999，34(1)：55-56．
6. Moran WB, Orr WC.Diagnosis and management of obstructive sleep apnea [J]. Part Ⅱ .Arch Otolaryngol. 1985,111(10):650-658.
7. Fairbanks DN . Operative techniques of uvulopalatopharyngoplasty [J] .Ear Nose Throat J, 1999, 78 (11) :846-850.
8. Friedman_M,Landsberg_R,Tanyeri_H.Submucosaluvulopalatopharyngoplas ty [J]. Op Tech Otolaryngol Head Neck Surg , 2000, 11 (1): 26C9.
9. Han D, Ye J, Lin Z , et al . Revised uvulopalatopharyngoplast with uvula preservation and its clinical study . ORL J Otorhinolaryngology Relat Spec,2005,67 (4) :213-219.
10. Kamami YV. Outpatient treatment of sleep apnea syndrome with CO2 laser: laser-assisted UPPP [J]. J Otolaryngol. 1994 ; 23(6):395-398.
11.Fujita S.Obostuctive sleep apnea syndrome : pathophysiology , upper airway evaluation and surgical treatment [J]. Ear Nose Throat J,1993,72(l):67-72,75-76.
12.Friedman M,Ibrahim H,Bass L.Clinical staging for sleep-disordered breathing [J]. Otolaryngol Head Neck Surg , 2002,127(1): 13-21.
13. Woodson BT.Transpalatal advancement pharyngoplasty for obstructive sleep apnea [J]. Op Tech Otolaryngol Head Neck Surg , 2000,11 (4):36C40.
14. Li KK, Powell NB, Riley RW, et al. Morbidly obese patients with severe obstructive sleep apnea syndrome: Is airway reconstructive surgery a viable option? [J]. Laryngoscope, 2000, 110 (6) :982-987.
15.Wise SK, Wise JC, DelGaudio JM .Gastroesophageal reflux and laryngopharyngeal reflux in patients with sleep-disordered breathing [J] .Otolaryngol Head Neck Surg . 2006 , 135(2):253-257.
1. Fujita S , Conway W, Zorick F et al . Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome uvulopalatopharyngoplasty [J]. Otolaryngol Head Neck Surg, 1981, 89(6): 923-934.
2. Elasfour A, Miyazaki S, Itasaka Y , et al Evaluation of uvulopalatopharyngoplasty in treatment of obstructive sleep apnea syndrome [J]. Acta Otolaryngol Suppl, 1998,537: 52-56.
3．孙建军 李进让．阻塞性睡眠呼吸暂停综合征的外科治疗-腭帆成型与口咽气道扩大[J]．解放军医学杂志．2002，27(2)：168-169．
4．中华医学会耳鼻咽喉科学分会 中华耳鼻咽喉科杂志编委会．阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准暨悬雍垂腭咽成形术适应证(杭州)．中华耳鼻咽喉科杂志，2002，37(6)：403-404．
5. Katarina Olofsson , Cecilia Mattsson Structure of the human uvula [J].Acta Otolaryngol, 1999,119 (6): 712-717.
6. Han D, Ye J, Lin Z, et al . Revised uvulopalatopharyngoplast with uvula preservation and its clinical study [J]. ORL J Otorhinolaryngology Relat Spec, 2005, 67 (4) :213-219.
7. Shott SR .Apnea and the elongated uvula. Int J Pediatr Otorhinolaryngol, 1992,242 (2) : 183-189.
8. Kimoff RJ,Sforza E,Champagne V ,et al. Upper airway sensation in snoring and obstuctive sleep aonea [J]. Am J Respir Crit Care Med .2001,164 (2) :250-255.
9. Larsson H, Carlsson-Nordlander B, Lindblad LE, et al . Temperature thersholds in the oropharynx of patients with obstuctive sleep aonea syndrome [J]. Am Rev Dis, 1992, 146 (5Pt1) :1246-1249.
10. Johm H , Boyd BJ , Petrof QH , et al. Upper airway muscle inflammation and denervation changes in obstuctive sleep apnea [J]. Am J Respir Crit Care Med . 2004 , 170(5): 541-546.
11. Han D, Ye J, Lin Z , et al . Revised uvulopalatopharyngoplast with uvula preservation and its clinical study [J]. ORL J Otorhinolaryngology Relat Spec,2005,67 (4) : 213-219.
12. Moran WB, Orr WC.Diagnosis and management of obstructive sleep apnea [J]. Part Ⅱ .Arch Otolaryngol. 1985,111(10):650-658 .
13. Fairbanks DN . Operative techniques of uvulopalatopharyngoplasty [J].Ear Nose Throat J, 1999, 78 (11) :846-850.
14. Friedman M,Landsberg R,Tanyeri H.Submucosaluvulopalatopharyngopla -sty[J] . Op Tech Otolaryngol Head Neck Surg , 2000, 11 (1): 26C9.
15. Friedman M,Ibrahim HZ,Vidyasagar R,etal.Z-palatoplasty(ZPP): a technique for patients without tonsils [J]. Otolaryngol Head Neck Surg , 2004 ,131 (1) :89 C100.
16.Kamami YV. Outpatient treatment of sleep apnea syndrome with CO2 laser: laser-assisted UPPP [J]. J Otolaryngol .1994 ; 23(6):395-398.
1．中华医学会耳鼻咽喉科学分会 中华耳鼻咽喉科杂志编委会．阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准暨悬雍垂腭咽成形术适应证(杭州)[J]．中华耳鼻咽喉科杂志，2002，37(6)：403-404．
2. Fujita S.Obostuctive sleep apnea syndrome : pathophysiology , upper airway evaluation and surgical treatment[J] .Ear Nose Throat J, 1993,72(1):67-72,75-76.
3. Friedman M,Ibrahim H,Bass L.Clinical staging for sleep-disordered breathing [J]. Otolaryngol Head Neck Surg, 2002,127(1): 13-21.
4．杨大海，李五一，神平，等．上气道压力测定在睡眠呼吸暂停低通气综合征诊治中的应用[J]．临床耳鼻咽喉头颈外科杂志，2008，22(4)：156-159．
5．刘月华，曾祥龙，傅民魁，等．阻塞性睡眠呼吸暂停综合征患者上气道及周围结构的头影测量[J]．中华口腔医学杂志，1999，34(4)：213．
6. Fujita S, Conway W, Zorick F, et al. Surgical correction of anatomic abnormalities in obstuctive sleep apneasyndrome : uvulopalatopharyngoplast [J]. Otolaryngol Head Neck Surg, 1981,89(6):923-934.
7. Moran WB, Orr WC . Diagnosis and management of obstructive sleep apnea [J]. Part Ⅱ .Arch Otolaryngol, 1985,111(10):650-658.
8. Fairbanks DN. Operative techniques of uvulopalatopharyngoplasty [J]. Ear Nose Throat J, 1999, 78 (11) :846-850.
9. Friedman M,Landsberg R,Tanyeri H. Submucosaluvulopalatopharyngopla-sty[J]. Op Tech Otolaryngol Head Neck Surg, 2000,11 (1):26C9.
10. Friedman M,Ibrahim HZ,Vidyasagar R,etal.Z-palatoplasty(ZPP): a technique for patients without tonsils [J]. Otolaryngol Head Neck Surg,2004 , 131(1) :89C100.
11．孙建军，李进让．阻塞性睡眠呼吸暂停综合征的外科治疗-腭帆成型与口咽气道扩大[J]．解放军医学杂志，2002，27(2)：168-169．
12. Han D, Ye J, Lin Z, et al. Revised uvulopalatopharyngoplast with uvula preservation and its clinical study [J]. ORL J Otorhinolaryngology Relat Spec, 2005, 67 (4):213-219.
13. Boot H,Poublon RM,Van Wegen R, et al. Uvulopalatopharyngoplasty for the obstructive sleep apnea syndrome:value of polysomnography ,Mueller manoeuvre and cephalometry in predicting surgical outcome [J]. Clin Otolaryngol Allied Sci, 1997,22(6):504-510.
14．卢晓峰，唐友盛，李青云，等．计算机辅助设计的定量UPPP手术及其评价[J]．中国口腔颌面外科杂志，2003，1(3)：138-142．
15. Boot H,van Wegen R,Poublon RM, et al ..Long-term results of uvulopalatopharyngoplasty for obstructive sleep apnea syndrome [J]. Laryngoscope,2000,110(3Pt1):469-475.
16. Osnes T, Rollheim J,Hartmann E.Effect of UPPPwith respect to site of pharynged obstuction in sleep apnea : follow-up at 18 months by overnight recoding of airway pressure and flow [J]. Clin Otolaryngol Allied Sci , 2002,27(1):38-43.
17. Woodson BT.Transpalatal advancement pharyngoplasty for obstructive sleep apnea [J]. Op Tech Otolaryngol Head Neck Surg, 2000, 11 (4) :36C40.
18. Li KK, Powell NB, Riley RW, et al. Overview of Phase I surgery for obstructive sleep apnea syndrome[J]. Ear Nose Throat J ,1999, 78 (11) :836-845.
19. Lee NR, Givens CD Jr, Wilson J, et al. Staged surgical treatment of obstructive sleep apnea syndrome: a review of 35 patients[J]. J Oral Maxillofac Surg,1999, 57 (4) :382-385.
20. Bettega G, Pepin J, Veale D, et al. Obstructive sleep apnea syndrome:Fifty-one consecutive patients treated by maxillofacial surgery[J]. Am J Respir Crit Care Med ,2000, 162 (1) :641-649.
21. Hsu PP, Brett RH. Multiple level pharyngeal surgery for obstructive sleep apnoea[J]. Singapore Med J ,2001, 42:160-164.
22. Li KK, Powell NB, Riley RW, et al. Morbidly obese patients with severe obstructive sleep apnea syndrome: Is airway reconstructive surgery a viable option? [J]. Laryngoscope, 2000, 110 (6) :982-987.
23. Li KK, Riley RW, Powell NB, et al. Obstructive sleep apnea surgery:patients' perspective and polysomnographic results[J]. Otolaryngol Head Neck Surg 2000, 123 (5) :572-575.
24. Li KK, Powell NB, Riley RW, et al. Overview of Phase Ⅱ surgery for obstructive sleep apnea syndrome[J]. Ear Nose Throat J, 1999 , 78 (12) :851-857.
25. Li KK, Powell NB, Riley RW, et al. Long-term results of maxillomandibular advancement surgery [J]. Sleep Breath ,2000, 4 (3) : 137-140.
26. Conradt R, Hochban W, Brandenburg U, et al. Long term results after surgical treatment of obstructive sleep apnea by maxillomandibular advancement[J]. Eur Respir J , 1997, 10 (1) :123-128.
27. Neruntarat C. Genioglossus advancement and hyoid myotomy under local anesthesia[J]. Otolaryngol Head Neck Surg, 2003, 129 (1) :85-91.
28. Verse T, Baisch A, Hormann K. Multi-level surgery for obstructive sleep apnea. Preliminary objective results[J]. Laryngorhinootologie ,2004, 83(4) :516-522.
29. Bowden MT, Kezirian EJ, Utley D, et al. Outcomes of hyoid suspension for the treatment of obstructive sleep apnea[J]. Arch Otolaryngol Head Neck Surg, 2005,131 (5) :440-445.
30. Miller FR, Watson D, Malis D. Role of the tongue base suspension suture with the Repose System bone screw in the multilevel surgical management of obstructive sleep apnea[J]. Otolaryngol Head Neck Surg ,2002,126 (4) :392-398.
31. Omur M, Ozturan D, Elex F, et al. Tongue base suspension combined with UPPP in severe OSA patients[J]. Otolaryngol Head Neck Surg ,2005, 133(2) :218-223.
32. Kuhnel TS, Schurr C, Wagner B, et al. Morphological changes of the posterior airway space after tongue base suspension[J]. Laryngoscope ,2005,115 (3) :475-480.
33. Vicente E, Marin JM, Carrizo S, et al. Tongue-base suspension in conjunction with uvulopalatopharyngoplasty for treatment of severe obstructive sleep apnea: long-term follow up results[J]. Laryngoscope ,2006,116 (7) :1223-1227.
34. Samuel A, Mickelson C, Leon Rosenthal.Midline Glossectomy Vanderbilt Epiglottidectomy for Obstructive Sleep Apnea Syndrome[J].Laryngoscope, 1997, 107 (5): 614-619.
35. Chabolle F, Wagner I, Blumen MB, et al. Tongue base reduction with hyoepiglottoplasty: a treatment for severe obstructive sleep apnea[J]. Laryngoscope,1999, 109 (8):1273-1280.
36．胡玉顺，薛建勇，盛迎涛，等．应用射频术与悬雍垂成形术治疗OSAHS患者近期疗效比较[J]．中国耳鼻咽喉颅底外科杂志．2008，14(4)：290-293．
1．李延忠，主编．睡眠呼吸障碍性疾病．济南：山东科学技术出版社，2005．8 P 210．
2. Demars SM, Harsha WJ, Crawford JV. The effects of smoking on the rate of postoperative hemorrhage after tonsillectomy and uvulopalatopharyngoplasty. Arch Otolaryngol Head Neck Surg. 2008 Aug; 134(8):811-4.
3. Coughlin S ,Mawdsley L ,Mugarza JA, et al. Obst ructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J ,2004,25:735-741.
4. Wise SK, Wise JC, DelGaudio JM .Gastroesophageal reflux and laryngopharyngeal reflux in patients with sleep-disordered breathing .Otolaryngol Head Neck Surg.2006, 135(2)253-7.
5．肖高辉，王智凤，柯美云 等．阻塞性睡眠呼吸暂停与胃食管反流的关系及对抗反流治疗的效果．中华内科杂志，1999，38(1)33-36．
6．韩德民，主编．睡眠呼吸障碍外科学．北京：人民卫生出版社2006，12 P101．
7．杭州标准中华医学会耳鼻咽喉科学分会 中华耳鼻咽喉科杂志编委会．阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准暨悬雍垂腭咽成形术适应证(杭州)．中华耳鼻咽喉科杂志，2002，37：403-404．
8．何权瀛，肖水芳，刘大波等．对阻塞性睡眠呼吸暂停低通气综合征诊疗标准(杭州标准)的讨论．中国耳鼻咽喉头颈外科．2006，13(7)427-430．
9．何权瀛．重视阻塞性睡眠呼吸暂停低通气综合征靶器官损害的防治研究．中华结核和呼吸杂志，2005，28(6)：362-363．
10. Treatment of Obstructive Sleep Apnea : No Longer Just a Lot of Hot Air Scott E. Chest, 2002, 121: 674-677.
11．韩德民．睡眠呼吸障碍疾病外科治疗的思考．中华耳鼻咽喉头颈外科杂志．2007，42(2)：81-82．
12. Sullivan CE, Issa EF, Borthon-Jones M, et al . Reversal of obstructive sleep apnea by continuous positive pressure applied through the nose.Lancet, 1981 , 1:862-865.
13. Suzuki M, Saigusa H, Kurogi R, et al Postoperative monitoring of esophageal pressure in patients with obstructive sleep apnea-hypopnea syndrome who have undergone tonsillectomy with uvulopalatopharyngoplas-ty.Ann Otol Rhinol Laryngol. 2008 Nov; 117(11):849-53.
14．宋西成，张庆泉，夏永宏等．阻塞性睡眠呼吸暂停低通气综合征患者的术后ICU监护．2008，22(5)：389-392．
15. Kezirian EJ, Weaver EM, Yueh B, et al. Incidence of serious omplications after uvulopalatopharyngoplasty. Laryngoscope 2004; 114(3):450-3.
16. Hathaway B, Johnson JT. Safety of uvulopalatopharyngoplasty as outpatient surgery. Otolaryngol Head Neck Surg. 2006,134(4):542-544.
17．侯静，许媛，何伟等．阻塞性睡眠呼吸暂停低通气综合征术后ICU治疗．2004，12(6)P377-378．
18．张连山，魏伯俊，王轶．重症阻塞性睡眠呼吸暂停综合征术前预防性气管切开的适应证．中华耳鼻咽喉科杂志，1995，30：138-139．
19．罗志宏，陈始明，陶泽璋等．减少悬雍垂腭咽成形术并发症的围手术期处理．中华耳鼻咽喉头颈外科杂志．2006，41(2)100-103．
20．金蔚，何敏，陈洪列，等．重度阻塞性睡眠呼吸暂停低通气综合征的围手术期处理．中国耳鼻咽喉头颈外科．2006，13(6)：414-416．
21．李燕，杨利，余成清，等．阻塞性睡眠呼吸暂停综合征术后镇痛的研究．现代医药卫生．2007，23(17)：2560-2561．
22. Practice guidelines for the perioperative management of patients with obstructive sleep apnea. A report by the American Society of Anesthesiologists Task Force on perioperative management of patients with obstructive sleep apnea. Anesthesiology 2006; 104:1081-1093.
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24. Dayall VS, Phillipson EA. Nasal surgery in the management of sleep apnea. Ann Otol Rhinol Laryngol 1985;94:550-554.
2. Elasfour A, Miyazaki S, Itasaka Y , et al Evaluation of uvulopalatopharyngoplasty in treatment of obstructive sleep apnea syndrome [J]. Acta Otolaryngol Suppl, 1998,537 : 52-56.
3．孙建军 李进让．阻塞性睡眠呼吸暂停综合征的外科治疗-腭帆成型与口咽气道扩大[J]．解放军医学杂志．2002，27(2)：168-169．
4．中华医学会耳鼻咽喉科学分会 中华耳鼻咽喉科杂志编委会．阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准暨悬雍垂腭咽成形术适应证(杭州)．中华耳鼻咽喉科杂志，2002，37(6：)403-404．
1. Fujita S , Conway W, Zorick F et al. Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome uvulopalatopharyngoplasty [J]. Otolaryngol Head Neck Surg, 1981, 89(6): 923-934.
2. Elasfour A, Miyazaki S, Itasaka Y , et al Evaluation of uvulopalatopharyngoplasty in treatment of obstructive sleep apnea syndrome [J]. Acta Otolaryngol Suppl, 1998,537: 52-56.
3．孙建军 李进让．阻塞性睡眠呼吸暂停综合征的外科治疗-腭帆成型与口咽气道扩大[J]．解放军医学杂志．2002，27(2)：168-169．
4．中华医学会耳鼻咽喉科学分会 中华耳鼻咽喉科杂志编委会．阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定 标准暨悬雍垂腭咽成形术适应证(杭州)．中华耳鼻咽喉科杂志，2002，37(6)：403-404．
5．刘文君 曹文强 葛瑞峰 等．阻塞性睡眠呼吸暂停综合征患者咽腔形态学测量[J]．中华耳鼻咽喉科杂志，1999，34(1)：55-56．
6. Moran WB, Orr WC.Diagnosis and management of obstructive sleep apnea [J]. Part Ⅱ .Arch Otolaryngol. 1985,111(10):650-658.
7. Fairbanks DN . Operative techniques of uvulopalatopharyngoplasty [J] .Ear Nose Throat J, 1999, 78 (11) :846-850.
8. Friedman_M,Landsberg_R,Tanyeri_H.Submucosaluvulopalatopharyngoplas ty [J]. Op Tech Otolaryngol Head Neck Surg , 2000, 11 (1): 26C9.
9. Han D, Ye J, Lin Z , et al . Revised uvulopalatopharyngoplast with uvula preservation and its clinical study . ORL J Otorhinolaryngology Relat Spec,2005,67 (4) :213-219.
10. Kamami YV. Outpatient treatment of sleep apnea syndrome with CO2 laser: laser-assisted UPPP [J]. J Otolaryngol. 1994 ; 23(6):395-398.
11.Fujita S.Obostuctive sleep apnea syndrome : pathophysiology , upper airway evaluation and surgical treatment [J]. Ear Nose Throat J,1993,72(l):67-72,75-76.
12.Friedman M,Ibrahim H,Bass L.Clinical staging for sleep-disordered breathing [J]. Otolaryngol Head Neck Surg , 2002,127(1): 13-21.
13. Woodson BT.Transpalatal advancement pharyngoplasty for obstructive sleep apnea [J]. Op Tech Otolaryngol Head Neck Surg , 2000,11 (4):36C40.
14. Li KK, Powell NB, Riley RW, et al. Morbidly obese patients with severe obstructive sleep apnea syndrome: Is airway reconstructive surgery a viable option? [J]. Laryngoscope, 2000, 110 (6) :982-987.
15.Wise SK, Wise JC, DelGaudio JM .Gastroesophageal reflux and laryngopharyngeal reflux in patients with sleep-disordered breathing [J] .Otolaryngol Head Neck Surg . 2006 , 135(2):253-257.
1. Fujita S , Conway W, Zorick F et al . Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome uvulopalatopharyngoplasty [J]. Otolaryngol Head Neck Surg, 1981, 89(6): 923-934.
2. Elasfour A, Miyazaki S, Itasaka Y , et al Evaluation of uvulopalatopharyngoplasty in treatment of obstructive sleep apnea syndrome [J]. Acta Otolaryngol Suppl, 1998,537: 52-56.
3．孙建军 李进让．阻塞性睡眠呼吸暂停综合征的外科治疗-腭帆成型与口咽气道扩大[J]．解放军医学杂志．2002，27(2)：168-169．
4．中华医学会耳鼻咽喉科学分会 中华耳鼻咽喉科杂志编委会．阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准暨悬雍垂腭咽成形术适应证(杭州)．中华耳鼻咽喉科杂志，2002，37(6)：403-404．
5. Katarina Olofsson , Cecilia Mattsson Structure of the human uvula [J].Acta Otolaryngol, 1999,119 (6): 712-717.
6. Han D, Ye J, Lin Z, et al . Revised uvulopalatopharyngoplast with uvula preservation and its clinical study [J]. ORL J Otorhinolaryngology Relat Spec, 2005, 67 (4) :213-219.
7. Shott SR .Apnea and the elongated uvula. Int J Pediatr Otorhinolaryngol, 1992,242 (2) : 183-189.
8. Kimoff RJ,Sforza E,Champagne V ,et al. Upper airway sensation in snoring and obstuctive sleep aonea [J]. Am J Respir Crit Care Med .2001,164 (2) :250-255.
9. Larsson H, Carlsson-Nordlander B, Lindblad LE, et al . Temperature thersholds in the oropharynx of patients with obstuctive sleep aonea syndrome [J]. Am Rev Dis, 1992, 146 (5Pt1) :1246-1249.
10. Johm H , Boyd BJ , Petrof QH , et al. Upper airway muscle inflammation and denervation changes in obstuctive sleep apnea [J]. Am J Respir Crit Care Med . 2004 , 170(5): 541-546.
11. Han D, Ye J, Lin Z , et al . Revised uvulopalatopharyngoplast with uvula preservation and its clinical study [J]. ORL J Otorhinolaryngology Relat Spec,2005,67 (4) : 213-219.
12. Moran WB, Orr WC.Diagnosis and management of obstructive sleep apnea [J]. Part Ⅱ .Arch Otolaryngol. 1985,111(10):650-658 .
13. Fairbanks DN . Operative techniques of uvulopalatopharyngoplasty [J].Ear Nose Throat J, 1999, 78 (11) :846-850.
14. Friedman M,Landsberg R,Tanyeri H.Submucosaluvulopalatopharyngopla -sty[J] . Op Tech Otolaryngol Head Neck Surg , 2000, 11 (1): 26C9.
15. Friedman M,Ibrahim HZ,Vidyasagar R,etal.Z-palatoplasty(ZPP): a technique for patients without tonsils [J]. Otolaryngol Head Neck Surg , 2004 ,131 (1) :89 C100.
16.Kamami YV. Outpatient treatment of sleep apnea syndrome with CO2 laser: laser-assisted UPPP [J]. J Otolaryngol .1994 ; 23(6):395-398.
1．中华医学会耳鼻咽喉科学分会 中华耳鼻咽喉科杂志编委会．阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准暨悬雍垂腭咽成形术适应证(杭州)[J]．中华耳鼻咽喉科杂志，2002，37(6)：403-404．
2. Fujita S.Obostuctive sleep apnea syndrome : pathophysiology , upper airway evaluation and surgical treatment[J] .Ear Nose Throat J, 1993,72(1):67-72,75-76.
3. Friedman M,Ibrahim H,Bass L.Clinical staging for sleep-disordered breathing [J]. Otolaryngol Head Neck Surg, 2002,127(1): 13-21.
4．杨大海，李五一，神平，等．上气道压力测定在睡眠呼吸暂停低通气综合征诊治中的应用[J]．临床耳鼻咽喉头颈外科杂志，2008，22(4)：156-159．
5．刘月华，曾祥龙，傅民魁，等．阻塞性睡眠呼吸暂停综合征患者上气道及周围结构的头影测量[J]．中华口腔医学杂志，1999，34(4)：213．
6. Fujita S, Conway W, Zorick F, et al. Surgical correction of anatomic abnormalities in obstuctive sleep apneasyndrome : uvulopalatopharyngoplast [J]. Otolaryngol Head Neck Surg, 1981,89(6):923-934.
7. Moran WB, Orr WC . Diagnosis and management of obstructive sleep apnea [J]. Part Ⅱ .Arch Otolaryngol, 1985,111(10):650-658.
8. Fairbanks DN. Operative techniques of uvulopalatopharyngoplasty [J]. Ear Nose Throat J, 1999, 78 (11) :846-850.
9. Friedman M,Landsberg R,Tanyeri H. Submucosaluvulopalatopharyngopla-sty[J]. Op Tech Otolaryngol Head Neck Surg, 2000,11 (1):26C9.
10. Friedman M,Ibrahim HZ,Vidyasagar R,etal.Z-palatoplasty(ZPP): a technique for patients without tonsils [J]. Otolaryngol Head Neck Surg,2004 , 131(1) :89C100.
11．孙建军，李进让．阻塞性睡眠呼吸暂停综合征的外科治疗-腭帆成型与口咽气道扩大[J]．解放军医学杂志，2002，27(2)：168-169．
12. Han D, Ye J, Lin Z, et al. Revised uvulopalatopharyngoplast with uvula preservation and its clinical study [J]. ORL J Otorhinolaryngology Relat Spec, 2005, 67 (4):213-219.
13. Boot H,Poublon RM,Van Wegen R, et al. Uvulopalatopharyngoplasty for the obstructive sleep apnea syndrome:value of polysomnography ,Mueller manoeuvre and cephalometry in predicting surgical outcome [J]. Clin Otolaryngol Allied Sci, 1997,22(6):504-510.
14．卢晓峰，唐友盛，李青云，等．计算机辅助设计的定量UPPP手术及其评价[J]．中国口腔颌面外科杂志，2003，1(3)：138-142．
15. Boot H,van Wegen R,Poublon RM, et al ..Long-term results of uvulopalatopharyngoplasty for obstructive sleep apnea syndrome [J]. Laryngoscope,2000,110(3Pt1):469-475.
16. Osnes T, Rollheim J,Hartmann E.Effect of UPPPwith respect to site of pharynged obstuction in sleep apnea : follow-up at 18 months by overnight recoding of airway pressure and flow [J]. Clin Otolaryngol Allied Sci , 2002,27(1):38-43.
17. Woodson BT.Transpalatal advancement pharyngoplasty for obstructive sleep apnea [J]. Op Tech Otolaryngol Head Neck Surg, 2000, 11 (4) :36C40.
18. Li KK, Powell NB, Riley RW, et al. Overview of Phase I surgery for obstructive sleep apnea syndrome[J]. Ear Nose Throat J ,1999, 78 (11) :836-845.
19. Lee NR, Givens CD Jr, Wilson J, et al. Staged surgical treatment of obstructive sleep apnea syndrome: a review of 35 patients[J]. J Oral Maxillofac Surg,1999, 57 (4) :382-385.
20. Bettega G, Pepin J, Veale D, et al. Obstructive sleep apnea syndrome:Fifty-one consecutive patients treated by maxillofacial surgery[J]. Am J Respir Crit Care Med ,2000, 162 (1) :641-649.
21. Hsu PP, Brett RH. Multiple level pharyngeal surgery for obstructive sleep apnoea[J]. Singapore Med J ,2001, 42:160-164.
22. Li KK, Powell NB, Riley RW, et al. Morbidly obese patients with severe obstructive sleep apnea syndrome: Is airway reconstructive surgery a viable option? [J]. Laryngoscope, 2000, 110 (6) :982-987.
23. Li KK, Riley RW, Powell NB, et al. Obstructive sleep apnea surgery:patients' perspective and polysomnographic results[J]. Otolaryngol Head Neck Surg 2000, 123 (5) :572-575.
24. Li KK, Powell NB, Riley RW, et al. Overview of Phase Ⅱ surgery for obstructive sleep apnea syndrome[J]. Ear Nose Throat J, 1999 , 78 (12) :851-857.
25. Li KK, Powell NB, Riley RW, et al. Long-term results of maxillomandibular advancement surgery [J]. Sleep Breath ,2000, 4 (3) : 137-140.
26. Conradt R, Hochban W, Brandenburg U, et al. Long term results after surgical treatment of obstructive sleep apnea by maxillomandibular advancement[J]. Eur Respir J , 1997, 10 (1) :123-128.
27. Neruntarat C. Genioglossus advancement and hyoid myotomy under local anesthesia[J]. Otolaryngol Head Neck Surg, 2003, 129 (1) :85-91.
28. Verse T, Baisch A, Hormann K. Multi-level surgery for obstructive sleep apnea. Preliminary objective results[J]. Laryngorhinootologie ,2004, 83(4) :516-522.
29. Bowden MT, Kezirian EJ, Utley D, et al. Outcomes of hyoid suspension for the treatment of obstructive sleep apnea[J]. Arch Otolaryngol Head Neck Surg, 2005,131 (5) :440-445.
30. Miller FR, Watson D, Malis D. Role of the tongue base suspension suture with the Repose System bone screw in the multilevel surgical management of obstructive sleep apnea[J]. Otolaryngol Head Neck Surg ,2002,126 (4) :392-398.
31. Omur M, Ozturan D, Elex F, et al. Tongue base suspension combined with UPPP in severe OSA patients[J]. Otolaryngol Head Neck Surg ,2005, 133(2) :218-223.
32. Kuhnel TS, Schurr C, Wagner B, et al. Morphological changes of the posterior airway space after tongue base suspension[J]. Laryngoscope ,2005,115 (3) :475-480.
33. Vicente E, Marin JM, Carrizo S, et al. Tongue-base suspension in conjunction with uvulopalatopharyngoplasty for treatment of severe obstructive sleep apnea: long-term follow up results[J]. Laryngoscope ,2006,116 (7) :1223-1227.
34. Samuel A, Mickelson C, Leon Rosenthal.Midline Glossectomy Vanderbilt Epiglottidectomy for Obstructive Sleep Apnea Syndrome[J].Laryngoscope, 1997, 107 (5): 614-619.
35. Chabolle F, Wagner I, Blumen MB, et al. Tongue base reduction with hyoepiglottoplasty: a treatment for severe obstructive sleep apnea[J]. Laryngoscope,1999, 109 (8):1273-1280.
36．胡玉顺，薛建勇，盛迎涛，等．应用射频术与悬雍垂成形术治疗OSAHS患者近期疗效比较[J]．中国耳鼻咽喉颅底外科杂志．2008，14(4)：290-293．
1．李延忠，主编．睡眠呼吸障碍性疾病．济南：山东科学技术出版社，2005．8 P 210．
2. Demars SM, Harsha WJ, Crawford JV. The effects of smoking on the rate of postoperative hemorrhage after tonsillectomy and uvulopalatopharyngoplasty. Arch Otolaryngol Head Neck Surg. 2008 Aug; 134(8):811-4.
3. Coughlin S ,Mawdsley L ,Mugarza JA, et al. Obst ructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J ,2004,25:735-741.
4. Wise SK, Wise JC, DelGaudio JM .Gastroesophageal reflux and laryngopharyngeal reflux in patients with sleep-disordered breathing .Otolaryngol Head Neck Surg.2006, 135(2)253-7.
5．肖高辉，王智凤，柯美云 等．阻塞性睡眠呼吸暂停与胃食管反流的关系及对抗反流治疗的效果．中华内科杂志，1999，38(1)33-36．
6．韩德民，主编．睡眠呼吸障碍外科学．北京：人民卫生出版社2006，12 P101．
7．杭州标准中华医学会耳鼻咽喉科学分会 中华耳鼻咽喉科杂志编委会．阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准暨悬雍垂腭咽成形术适应证(杭州)．中华耳鼻咽喉科杂志，2002，37：403-404．
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