To Analysis How The Size Of Tonsil Affects The Curative Effect Of Uvulopalatopharygoplasty

Obstructive sleep apnea-hypopnea syndrome(OSAHS) involve several clinical department, including pulmonology, neurology, cardiology, stomatology, otorhinolaryngolgy and etc. As for its high morbidity and complication, and with doctor's aware, it has become a hotspot. Now there are two main directions in treatment: surgery or conservative therapy. In most patients, the main site of narrowing were located at the level of soft palate, so the commonest operation is uvulopalatopharyngoplasty (UPPP); while the representative of conservative is continuous positive airway pressure (CPAP). Both of them have their and merit deficient. Sometimes we are puzzled to make a decision, as the professional guide is not so consistent. In fact, the decision most depends on the effect and the feasibility of the surgery. UPPP have developed for 20 years, the post-operation effect is a problem, which patients and doctors concern on. But unfortunately, Mata analysis shows that the UPPP's entire effective rate is about 40%. It blocks its development. So many scholars study from different aspect. We should control weight to improve curative effect and set down surgical project according to the obstructive level. At the same time, the severe of the disease pre-operation also affect the result obviously. But there is no paper about how the size of tonsil affects the curative effect of UPPP in OSAHS. While we all know that the tonsil is an important component of the soft palate and associated with the air way fluency at soft palate level. In clinical work, we observed that the patient with bigger tonsil would receive better result (in spit of the AHI). So when the other aspects take into account, can we suppose that size of the tonsil will influence the curative result? Hope to get an answer through this research. During Jun 1998 to Jun 2004, 54 patients with OSAHS or simple snore were enrolled and received UPPP in our department (48 males, 6 females). All the patients denied previous history of rhinitis, chronic pneumopathy and nerve-muscle disease. All the cases were diagnosed by PSG and accomplished by a same doctor at his mature skill stage. 1. Preoperative prepairation: 1) Common check: routine detect for blood and urine, blood biochemistry, electrocardiogram, X-ray examination for chest, etc; 2) Detailed check-up for specialty and common; 3) All the patients were diagnosed by PSG; 4) Through the MÇ–ller maneuver under fiberoptic laryngoscope, the narrowing site were located at the level of soft palate. 2. Operational style: Modified UPPP, all the case were accomplished by same doctor. 3. Postoperative following up:One year or above after surgery, the patients were checked up for common and specialty then we get long term curative effect. 4. Statistical analysis: All the data were analyzed with SPSS11.5 for windows. 1. The results of 31 patients after surgery (57.4%) are satisfied, while the other (23 patients) is not satisfied. 2. In all the 54 cases, the curative effects are as follows: mild 57.1%, moderate 42.9%, severe 60%. 3. There is no statistical difference in AHI, BMI and age between our patients with different size tonsils. 4. There is statistical difference in rate of curative between our patients with different size tonsils. 5. In no-effective group(16 cases) in severe OSAHS, there are 11 patients with â… grade tonsil and 5 patients with â…¡or â…¢tonsil; In effective group(24 cases) in severe OSAHS, there are 8 patients with â… grade tonsil and 16 patients with â…¡or â…¢tonsil. There is statistical difference in the component of different size tonsil in severe OSAHS. 1. Patients with OSAHS with different size tonsil have different curative-effect, when the other factors were considered. 2. We should treat the severe OSAHS with different policy. 3. We suggest that we should operate to the moderate OSAHS cautiously if there is no obvious obstructive site. 4. AHI is important to diagnose and grade in OSAHS, but it should not be the only reference to the decision of therapy. We should emphasize the individualization and normalization.