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目的 :比较手术、等离子体消融及持续经鼻正压通气对阻塞性睡眠呼吸暂停综合征 (OSAS)的疗效 ,探讨最佳治疗途径。方法 :将 45 0例OSAS患者分为 3组 ,其中手术组 3 68例〔包括悬雍垂腭咽成形术 (UPPP)3 0 2例 ,UPPP加舌根部分切除术 (PERT) 4 9例 ,UPPP加下鼻甲部分切除术 (PIT) 11例 ,UPPP加PERT加PIT 6例〕 ;等离子体消融 (CPS)组 65例 ;鼻腔持续正压通气 (nCPAP)组 2 5例 ,其中 17例为首选治疗 ,8例为手术失败后治疗。结果 :nCPAP组的近远期疗效 ( 95 .2 3 %及 83 .3 3 % )均高于手术组及CPS组 ,手术组与CPS组的近期疗效相近 ,分别为 86.3 9%及 78.0 4%。手术组的远期 ( 1~ 3年 )疗效尚达不到 5 0 % ,并随时间延长而继续下降 ,且具有一定的危险性和并发症。CPS组和nCPAP组的副作用小 ,无明显并发症。结论 :OSAS的治疗应趋向于安全、简单、有效 ,并易于患者接受 ,重度患者应接受nCPAP或较简单安全的手术治疗 ,UPPP、CPS及nCPAP均对中轻度患者有较好的疗效 ,可由患者与医生根据具体情况作出适当的选择。CPS的远期疗效有待进一步观察
OBJECTIVE: To compare the curative effects of surgery, plasma ablation and continuous nasal positive pressure ventilation on obstructive sleep apnea syndrome (OSAS) and to explore the best therapeutic approach. Methods: One hundred and forty-five OSAS patients were divided into three groups, including 368 cases of operation group (including 302 cases of uvulopalatopharyngoplasty (UPPP), 49 cases of UPPP plus partial resection of the tongue (PERT), UPPP (Including 11 cases of PIT, 6 cases of UPPP plus PERT and PIT), 65 cases of plasma ablation (CPS) and 25 cases of nasal continuous positive pressure ventilation (nCPAP), of which 17 cases were the first choice for treatment , 8 cases after the failure of treatment. Results: The short-term and long-term effects (95.23% vs 83.33%) in nCPAP group were higher than those in operation group and CPS group. The short-term curative effect of operation group and CPS group were 86.3% and 78.4% . The long-term (1-3 years) efficacy of the operation group still did not reach 50%, and continued to decline with time, and has some risks and complications. The side effects of CPS group and nCPAP group were small with no obvious complication. Conclusion: The treatment of OSAS should tend to be safe, simple, effective and easy for patients to accept. Severe patients should be treated with nCPAP or simple and safe surgical treatment. UPPP, CPS and nCPAP have better curative effect in mild to moderate patients Patients and doctors make the appropriate choice according to the specific situation. Long-term efficacy of CPS needs further observation