Progress in surgical treatment of OSAS and evaluation of the efficacy of UPPP after surgery
Classification of sleep apnea syndrome (SAS):
1.Obstructive sleep apnea syndrome (OSAS)
2, central sleep apnea syndrome (central sleep apnea syndrome. CSAS)
3.Sleep hypoventilation syndrome (Sleep hypoventilation syndrome)
The first part of OSAS surgical treatment tools
Preface: 1. Surgical treatment is an effective treatment for OSAS.
2.The assessment of postoperative symptom improvement before surgical treatment is difficult.
3, The development of surgical plan and prevention of postoperative complications are very important.
Etiology: The cause of OSAS is not well understood, but anatomical abnormalities in the upper airway of OSAS patients are certain, and this directly leads to the occurrence of airway obstruction during sleep, which is mainly located in the nasal cavity, pharynx and tongue.
I. Nasal surgery
1.Nasal septum correction
2.Double inferior turbinate or middle turbinate reduction surgery
3.Nasal polyp removal
4.Proliferative scraping: mostly seen in pediatric OSAS caused by hyperplasia of proliferators and tonsils.
Second, pharyngeal surgery
1.Uvulopalatolharyngoplasly UPPP was first established by Fujita in 1981 to treat OSAS, although there are many improved procedures, but the effect of treatment is certain. patency of the upper airway.
Indications.
(1) Clinical and X-ray examination confirms that the upper airway stenosis is located at the palatopharyngeal level.
(2) Flaccid soft palate, wide and long uvula, small oropharyngeal cavity.
(3) Apnea index AHI 50%.
(4) No obvious cardiopulmonary complications and no obvious abnormalities on ECG.
Complications.
(1) Nasopharyngeal stenosis: its occurrence is directly related to surgical brutality or even excessive local injury, damage to the mucosa of the posterior pharyngeal wall and excessive intraoperative removal of the pharyngeal mucosa. A few of them are caused by local infection secondary to surgery. Therefore, we emphasize the skillful operation technique and pay attention to the protection of the mucosa of the posterior pharyngeal wall, especially the mucosa of the posterior arch should not be excessively removed. In addition, strengthen the application of antimicrobial agents to avoid infection.
(2) Postoperative bleeding: it is mainly related to insufficient intraoperative hemostasis. In addition to giving the necessary hemostatic drugs, local treatment is often essential. Bleeding that occurs more than 24 hours after surgery is often the result of improper feeding or infection.
(3) Acute airway obstruction: In some patients with moderate to severe OSAS and overweight patients, delayed extubation until the patient is fully awake can be considered after surgery. The nasal cannula can be kept for 24 hours, and CPAP can be given for 2 weeks after surgery in hospitals where available. These measures can avoid postoperative tracheotomy due to acute airway obstruction.
Other complications are.
①Local wound pain: (omitted)
②Dry throat and foreign body sensation in the pharynx: (omitted)
③Altered pronunciation and open nasal voice: (omitted)
Contraindications to surgery: Absolute contraindications are rare, including uncontrolled hypertension, dentition, cleft palate, pre-existing palatopharyngeal insufficiency, snoring or OSA due to anatomical abnormalities of the oropharyngeal cavity not caused by palatopharyngeal soft tissue.
2.Laser uvulopalatopharyngoplasty (Laser UPPP)
Kakami (1990) first reported the application of CO2 laser to make curved incisions along the edge of the uvula and above its root on both sides for excision, which can shorten the soft palate and uvula, improve ventilation and reduce or eliminate snoring. The procedure can be performed under local anesthesia with CO2 laser power of 1-2W. The advantages are less intraoperative bleeding and mild postoperative reaction.
C. Tongue surgery
1.CO2 laser partial resection of tongue root: Koopmann reported in 1990 that CO2 was applied to resect the midline part of the tongue root, i.e., a wedge-shaped resection between the blind foramen and the median sulcus of the tongue, 2 cm wide and 1-2 cm deep, suitable for OSAS patients with posterior displacement of the tongue root or hypertrophy of the tongue body and narrowing of the posterior airway of the tongue.
2.CO2 lymphadenectomy: For OSAS patients with obvious hyperplasia of lymphatic tissue at the root of the tongue, CO2 can be used to remove the lymphatic tissue at the root of the tongue, but it is easy to bleed during the operation.
4.Maxillary surgery
1.Maxillary osteotomy and chin and tongue muscle advancement
2.Hyohyoid muscle suspension
3.Mandibular anterior transposition
Tracheotomy: This method is the earliest and most reliable surgical method for the treatment of obstructive sleep apnea syndrome, and the first surgeon to perform this operation was Kuhlo.
Indications:
1. Severe OSAS with severe hypoxemia, AHI > 50 times/hour during sleep, with a minimum SaO25 as the judgment criterion. A total of AI, HI, AHI, mean hypoxia saturation, and mean oxygen saturation were recorded for analysis.
2. OSAS diagnostic grading.
①Mild: AHI 5-20, SaO2>0.9, no systemic systemic diseases associated with it.
②Moderate: AHI 21～40, SaO2＞0.85, with or without associated systemic systemic diseases.
③Medium-severe: AHI 41～60, SaO2 0.75～0.85, with associated cardiovascular diseases.
④Severe: AHI > 60, SaO2 < 0.75, with associated systemic systemic diseases.