Palatophargngeal Measurement Of Patients With Obstructive Sleep Apnea-hyponea Syndrome Before And After Uvula Remaining For Uvulopalatopharyngoplasty And Evalucation Of Postoperative Effectiveness

Objective: Uvulopalatopharyngoplasty has been mostly clinical means for obstructive sleep apnea-hyponea syndrome (OSAHS) since 20 years ago. The operation extends the site of orophargngeal section, widens airway and improves ventilation by removing obese uvula, lax soft palate, plump tongue and anterior pillars. The efficiency is about 50%~80%. While symptoms of OSAHS are cleared away, complications such as velopharyngeal insafficiency are emerged and the shape of pharynx is abnormal after UPPP. International scolars has done a great deal of work and tried many ways in improving operating technique. They could not agree with each other especially in extensions of removing uvula and soft palate. So it is very necessary for measuring the site of palatopharyngeal cavity and evaluating effectiveness in patients with obstructive sleep apnea-hyponea syndrome before and after uvula remaining palatopharyngoplasty(URPPP). It is important for us to understand the relationship of OSAHS and transformation of anatomical morphology in order to select appropriate surgical approach. Thus theory and experience for OSAHS can be enriched. Methods: All of the objects were measured the site of pharyngnx, the patients with OSAHS underwent polysomnography and accepted uvulopalatopharyngoplasty (UPPP) or uvula remaining for uvulopalatopharyngoplasty (URPPP). 1 Selecting observed objections. 72 male patients with OSAHS, who are obstructive in orolphargnx with the Muller maneuver, were selected in polysomnography. They are classified randomly into two groups: the group of uvulopalatopharyngoplasty(UPPP) and the group of uvula remaining for uvulopalatopharyngoplasty (URPPP), which respectively contains 34 cases with aged 31~55 and a mean (+/-SD) age of 42.68±9.06 and 38 cases with aged 31~56 and a mean age of 43.36±8.66. The control group was consisted of 20 patients without OSAHS with aged 30~56 and a mean age of 42.85±8.72 in our patient department during synchronization. 2 Palatopharyngeal cavity measurement. Palatopharyngeal data in all of the control group and operation group were measured by ruler and scaled-pincers and scaled-needle maded by ourselves and that were measured in the operation group before and after operation. Palatopharyngeal data in all objects are as follow: length of soft palate(LSP), length of uvula(LU), distance between anterior pillars(DBAP), distance between posteriorpillars (DBPP), distance between uvula and posterior pharyngeal wall(DBUPPW), distance between uvula and back of tongue (DBUBT). 3 Polysomnography(PSG). All cases underwent PSG (tracing electro-oculogram, genioglossus electromyogram, mouth-rrhinia airflow, stetho-abdomen movement and saturation of blood oxygen of finger tip) for 7 hours in sleeping laboratory, monitored time-synchronized electrocardiogram and data were automatically recorded, stored, analyzed on international criterion by computer. The results were worked out by intellectuality. The second PSG would be arranged in 6 months later for the postoperative patients. 4 Operation methods. All of cases with OSAHS were arranged tonsillectomy according to dissection method disregarding the site of tonsilla under entire anaesthesia. The cases in UPPP were removed their part or full uvulas and retained soft palates acording to normal palatopharyngeal data. But the uvulas of the cases in URPPP were integrally remained and part of their soft palates was removed in the shape of 'v'beside uvula, issue of soft palate were separated obtusely and muscles of soft palate were protected when the fattiness tissue betweeen muscles were removed away. At last, posterior pillars and anterior pillars were sewed on the side wall of pharynx in order that there was no cavity in tonsillar nest. Results: 1 The pharyngeal cavity of patient with OSAHS (containing the UPPP and the URPPP) is smaller than that ofnormal adult man. The difference of palatopharyngeal data between patients with OSAHS and the control group is found. The difference of length of soft palate and length of uvula betweeen patients with OSAHS and control objects didn't reveal statistical significance. Distance between posterior pillars of the patients with OSAHS is smaller than that of control men(p<0.05). The difference of the distance between anterior pillars, distance between uvula and pharyngeal wall and distance between uvula and back of tongue and body mass index(BMI) between two groups is notable. The data of BMI correlats negatively with that of distance between uvula and back of tongue, distance between posterior pillars and distance between uvula and pharyngeal wall,positively with length of soft palate and length of uvula. The relationship of the data of AHI with that of length of soft palate, length of uvula and BMI is positive correlation, that of the data of AHI with that of distance between uvula and back of tongue, distance between posterior pillars, distance between anterior pillars and distance between uvula and pharyngeal wall is negative correlation. 2 Palatopharyngeal data of patients in the UPPP and the URPPP both of preoperation and postoperation 6 months later are respectively simetly (p>0.05). There was no difference in the percent of changes of palatopharyngeal data between the UPPP and the URPPP postoperation 6 months later (p>0.05). The difference of palatopharyngeal data between preoperation and postoperation both of the UPPP and the URPPP is significant(p<0.01). 3 Analysing relative complication of effectiveness of operation. There isn't any difference in data of AHI, maximum of oxegen decrease, average SaO2 of preoperation and postoperation between the UPPP and the URPPP(p>0.05). The percent of the decrease of AHI don't correlate with the data of distance between anterior pillars and with all of the data of length of soft palate, length of uvula and the pecents of their decrease, it remains positive correlation with the data of distance between uvula and back of tongue, distance between posterior pillars , distance between uvula and pharyngeal wall and BMI, it remains negative correlation with the percent of the changes of the data of distance between uvula and back of tongue, distance between posterior pillars and distance between uvula and pharyngeal wall. 4 Complications in UPPP are obviousely higher than that in URPPP postoperation. Conclusion: The pharyngeal cavity of patient with OSAHS is notably smaller than that of normal adult man. Though lengths of soft palate and uvular in patient with OSAHS are longer than those in the control group, OSAHS can not mostly attribute to lengths of soft palate and uvular. AHI correlates negatively with the site of the pharyngeal cavity, OSAHS is the result of the complex action of every structure in pharyngeal cavity. The effectiveness of operation has no relationship with lengths of soft palate and uvular both preoperation and postoperation.