Surgical treatment of obstructive sleep apnea hypopnea syndrome

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Modified UPPP technique for surgical treatment of patients with obstructive sleep apnea hypopnea syndrome. Because the traditional UPPP afte

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Modified UPPP technique for surgical treatment of patients with obstructive sleep apnea hypopnea syndrome. Because the traditional UPPP after operation with open rhinolalia, deglutition and dry feeling, foreign body sensation, nasopharyngeal cavity stenosis and other complications and sequelae. The characteristics of modified UPPP operation is uvula. In recent years, has found the uvula swallowing and breath phonation function to maintain airway tension preserving uvula pharyngeal cavity and normal physiological function has an important role. Uvula did not influence the effect of surgical treatment, it plays a key role in preventing the velopharyngeal insufficiency complications, make patients more fully formed soft palate. Complete preservation of uvula, anatomic resection the velopharyngeal space of adipose tissue, expand the scope of forming as much as possible to retain the soft palate, pharynx basic anatomy, rely on muscle of uvula after operation, levator veli palate, soft palate movement and both sides of palatosalpingeus healing caused by upward and outward pulling effect, the uvula can gradually retraction caused by normal physiological the level of. The utility model can not only effectively expand the pharyngeal cavity, improve the curative effect of UPPP operation, but also avoid the occurrence of postoperative complications. In patients with type OSAHS, UPPP alone can not solve the problem of tongue hypertrophy. The principle of TCRF is low temperature ablation, tongue TCRF treatment of moderate to severe OSAHS clinical attention. 90 cases were followed up for, and the upper airway obstruction was examined by PSG and no signs of recurrence. Were 108 after 1 years, 30 cases of patients with snoring again, suffocating symptoms, the PSG examination, AHI index increased (> 5), the AHI index was 9.5 ~ 16.5, close to the moderate, and is associated with recurrence of symptoms.

Type III obstructive sleep apnea hypopnea syndrome patients, adopt different methods of operation, in the short term there were snoring disappeared, no breath, sleep quality, self-report indexes are all full of go, the body tends to be normal, but after 1 years of follow-up found: the modified UPPP surgery plus TRCF in patients with AHI the modified UPPP index was significantly lower than that of patients. Compared with modified UPPP, the apnea index was significantly lower after modified UPPP and TRCF. Analysis of the reasons, found that type III patients underwent modified UPPP only solved the problem of oropharyngeal stenosis, in patients with pharyngeal stenosis do not understand the situation, in which part of the throat obstruction without stenosis in patients with complete remission, causing postoperative long-term effect is poor. The combination of multiple techniques is the key to improve the cure rate of type OSAHS.

Long term efficacy of type OSAHS. Due to the abnormal pharyngeal airway muscle function: breath tract dilator contraction is an important force to maintain an open airway. Awake, genioglossus muscle activity in patients with OSAHS is to reach its maximum activity of 40%, much lower than that of normal people 12% level high, suggesting that in order to maintain the upper airway open, the upper airway muscle activity compensatory enhancement. If there is no such compensatory activity, it is possible to improve the upper airway resistance when awake, or even apnea. During sleep, the OSAHS changes of patients with upper airway muscle activity was significantly different from the normal people, began to sleep, you can see the genioglossus inspiratory phasic activity decreased, tension activities other dilator was also decreased, the disappearance of reflex compensatory activities of inspiratory negative pressure enhanced, not against the chest and abdomen of ventilator inspiratory negative pressure generated the occurrence of apnea. In addition, the weakening of the upper airway muscle activity can also increase the compliance of the pharyngeal airway. It is not clear that the exact mechanism of OSAHS in patients with pharyngeal airway dysfunction. Through the study of this disease susceptibility factor found that angiotensin converting enzyme gene allele 1 may be susceptible to the disease gene, OSAS and a variety of genetic, genetic variation and susceptibility to disease. Therefore, it is of great significance to detect the polymorphism of ACE gene I/D, and to take appropriate preventive measures to prevent the occurrence of OSAHS and complications in high-risk population screening OSAHS.

 

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