| ObjectiveObstructive sleep apnea - hypopnea syndrome (OSAHS) is a serious medical problem resulting in snoring, apnea, oxygen saturation down, daytime sleepiness due to upper airway obstruction and collapse . For apnea, multiple system organs are injuried by ischemia - hypoxia. Upper airway obstruction is the importance cause of OSAHS. Uvulopalato - pharyngoplasty ( UPPP) is a kind of mostly method for OSAHS, but not definitely safely, the death cases once were reported. The purpose of this study is to investigate the effect and security of UPPP in patients with OSAHS, the range of the soft palate excision, and impersonality standard for improving low oxygen after UPPP.Materials and methods1. Patient Selection; a prospective study was designed to evaluate 34 adult patients with OSAHS ,who were required UPPP,and 27 adult patients who were referred for ear operation between November 1,2002,and November 1,2003. patients were required to have symptomatic subjective documentation and documented on polysomnography(PSG). OSAHS group:34 males, average aged43 years (range 22 -66 years). Normal group: 27 males, average aged 38 years (range 18-68 years) ,and no snore.2. methods: blood routine and palatopharyngeal data in two groups were measured before operation and 15 - 20 days after operation, and fellow up 6 months. The data before and after operation were analysed in statistical method(ttest).Results1. Palatopharyngeal data of normal and OSAHS group are as followed, length of softpalate,distance of pharyx and distance of palatopharyx were significantly different except for length of uvula( independent t test, p < 0.01). The data in OSAHS group was significantly different before and after operation (paired- sample t test, p < 0.01).2. Red blood cell (RBC), hemoglobin (HGB) and hematocrit (HCT) were significantly different in normal and OSAHS group (independent t test,p < 0. 01). Their indexes were significantly different in OSAHS group before and after operation, but inside normal value (paired - sample t test,p <0.01).3. Only HGB and the lowest SaO2 was negative correlation before operation in OSAHS group. The value is bigger for HGB and smaller for Sa02(t test,p < 0.01).4. Perioperative complications: There were 6 cases of temporatory soft palatal incompetence (17.6% )after operation, and disappeared after 3-4 days. 2 cases had pharynx bleeding(5. 9% ) , 5 cases had short time breathe obstacle (14.7% ). All cases of tracheotomy were extubated after 5 to 7 days. 10 cases with tracheotomy had wound infection and dehiscense (58. 8% ) , and entirety concrescence after 10 to 15 days.5. Result of follow up 6 months (31 cases) : Recovery was 9.7% , high efficacy was 64.5% , efficacy was 22.6% , and inefficacy was 3.2%. The effective ratio was 74.2% , and the total effective ratio was 96. 8% , including snore entirety disappear (9. 7%) and high efficacy (64. 5% ) , daytime sleepiness entirety disappear (71% )and high efficacy (32.3% ) , pharynx dry (58% ). 1 case has reflux of nasopharynx.Discussion1 . About postoperative effectThe overseas reported that the effect rate of UPPP 6 months was 64%. From our paper can see out the subjective symptoms of illness to be ameliorative to show the efficiency to 74. 2%. The reason of low effective ratio is probably for:(1)OSAHS involves multiple levels of obstruction and is not simply limited to the retropalatal region.(2) The factor for adult with apnea is mostly mixed, but operation only to solve peripheral block.(3) The patients with OSAHS have metabolic disorder of lipid. The overmuch fat in the pharynx gradually jams the air passage and does not get to recti-fy-(4) Not easy solution of plump of narrow mandible and root of tongue.Therefore, OSAHS should synthesize the treatment. This text it is daytime sleepiness that was improved the most obviously.2. As for the range UPPP excisionThe soft palate excision scope has the important influence to operation effect and postoperative complication. How...
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