Clinical Studies Of Uvulopalatopharyngoplasty Combined With Nasal Expansion In Treating OSAHS

Objective:To deeply investigate the relationship between the nasal congestion and obstructive sleep apnea hypopnea syndrome by the method of prospective cohort study, and carrying on the long-term follow-up for research object to explore the short term and long-term effect for OSAHS patients with the UPPP combined with nasal expansion and single plane surgery. Further determine the clinical efficacy of different surgical treatment of OSAHS with multi-planar obstruction.Method:By clinical examination and PSG monitoring confirmed, located by parallel electronic fiber laryngoscope and imaging examination,90patients with OSAHS who are all mainly blocked with pharyngeal plane above, they were randomly divided into three groups A group treated by the uvulopalatopharyngoplasty(UPPP), B groups treated by nasal expansion surgery (nasal septum+dual inferior turbinate partial resection), C groups treated by the nose and pharynx combined surgery (uvulopalatopharyngoplasty+nasal septum+dual inferior turbinate partial resection). All patients are routine treated continuous positive airway pressure5-7d. In order to evaluate the short-term and long-term clinical effect and comprehensive evaluate the short-termand long-term clinical effect among different surgery, polysomnography, Apnea Graph, snoring scale, OSAHS Quebec sleep questionnaire and Epworth Sleeping Scale and electronic fiber laryngoscope have been done preperative, postoperative6months and1year respectively.Results:After three surgical, the snoring score, ESS score, QSQ score, PSG indicators all have a certain improvement, and upper airway improved to varying degrees, the differences have statistically significant (P<0.05); The the nose and pharynx combined surgery have more significant improvements than angioplasty alone uvula velopharyngeal and simple nasal cavity expansion surgery on subjective indicators scores, PSG indicators, sleep architecture and airway obstruction improvement at6months and1year after surgery, the differences have statistically significant (P<0.05); What is more, compared to6months after surgery each indicator of1year after surgery has no significant change, the difference was not statistically significant (P>0.05). Compared with simple nasal cavity expansion surgery, the UPPP have more significant improvements each indicator, the differences have statistically significant (P<0.05); Simple nasal surgery have certain effect to improve airway collapse in palatal area and tongue area, the differences have statistically significant (P<0.05). Comparison the three kinds of surgical postoperative effect:6months and1year after the nose and pharynx combined surgery, total efficiency and most of the subjective, objective indicators of improvement is greater than the UPPP, and The surgical curative effect with UPPP group is more obviously compared with the imple nasal cavity expansion surgery, the differences have statistically significant (P<0.05).Conclusion:The UPPP and the simple nasal cavity expansion surgery may reduce the apnea-hypopnea index (apnea-hypopnea index AHI), raising the minimum oxygen saturation and quality of life of patients, but the effect is still limited; While the nose and pharynx combined surgery can compensate for the lack of these two procedures aboved to obtain relatively better therapeutic effect. The experiment research laid the foundation for the future conduct of other multi-planar joint surgery in the treatment of OSAHS, such as nasal surgery expansion joint tongue reduction surgery, UPPP joint tongue reduction surgery and nasal cavity, pharynx, palate, tongue three narrow parts of the joint operation. Meanwhile, this topic provide objective basis for exploreing the role of the upper airway stenosis in the cause of OSAHS.