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目的:探讨低温等离子射频消融术(RFA)在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)中应用的疗效及适应证。方法:对74例OSAHS患者(轻度16例,中度23例,重度35例)分别行不同狭窄部位的射频治疗,术后早期观察术区反应,评价射频治疗对局部疼痛、讲话、吞咽的影响;术后3个月检查治疗部位的体积,测量软腭和悬雍垂长度;术后6个月复查PSG、嗜睡量表及打鼾等级评分问卷调查,并与术前比较。主要依据PSG结果评价总有效率。结果:在74例患者中,治愈率为6.76%,显效率为27.03%,有效率为22.97%,总有效率为56.76%。术后AHI和最低SaO2均较术前改善(均P<0.01)。对于所有狭窄部位均得到射频治疗的患者,其总有效率为72.92%,优于尚有狭窄部位未处理的患者(P<0.01)。射频治疗后白天嗜睡程度和鼾声评级均较术前改善(P<0.01)。手术对局部疼痛、讲话及吞咽的影响很小。术后3个月大部分射频治疗过的部位,体积(或长度)均较术前明显缩小(或缩短)。结论:RFA对局部组织的消融效果确切,只要阻塞定位准确,相应治疗OS-AHS患者近期均有一定疗效。单纯鼻甲肥大所致鼾症或轻度OSAHS,射频治疗效果最为满意,软腭肥厚悬雍垂肥大、扁桃体肥大的治疗部分有效,但程度有限。射频治疗需要与其他治疗手段结合使用,或作为其他治疗的补充手段。
Objective: To investigate the efficacy and indications of cryogenic plasma radio frequency ablation (RFA) in obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: Totally 74 patients with OSAHS (mild 16, moderate 23, severe 35) underwent radiofrequency ablation at different sites of stenosis. Early postoperative observation of regional response and evaluation of radiofrequency ablation on local pain, speech, swallowing The volume of the treatment site was measured at 3 months after operation. The length of the soft palate and uvula were measured. The PSG, lethargy scale and snore rating scale questionnaire were reviewed at 6 months after operation and compared with those before operation. Mainly based on PSG results to evaluate the total efficiency. Results: Among the 74 patients, the cure rate was 6.76%, the effective rate was 27.03%, the effective rate was 22.97% and the total effective rate was 56.76%. The postoperative AHI and the lowest SaO2 were both improved (all P <0.01). The total effective rate was 72.92% in patients with all the stenoses treated with radiofrequency ablation, which was better than that in patients with no stenosis (P <0.01). The frequency of daytime sleepiness and snore rating after radiofrequency treatment were improved compared with that before operation (P <0.01). The impact of surgery on local pain, speech and swallowing is minimal. At 3 months after operation, most of the radiofrequency ablation sites (volume, or length) were significantly reduced (or shortened) compared with that before operation. Conclusion: The ablation effect of RFA on the local tissue is exact. As long as the accurate positioning of the obstruction, the corresponding treatment of OS-AHS patients have a certain effect in the near future. Simple turbinate hypertrophy caused by snoring or mild OSAHS, RF most satisfactory treatment, soft palate hypertrophy uvula hypertrophy, tonsil hypertrophy treatment part of the effective, but to a limited extent. RF therapy needs to be used in conjunction with other therapies or as a supplement to other therapies.