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目的:研究阻塞性睡眠呼吸暂停综合征(OSAS)患者的颌下腺以及这种颌下腺与OSAS的关系;研究摘除这种颌下腺对OSAS的疗效。方法:对20例OSAS患者颌下腺进行体检,影像学检查包括螺旋CT扫描和核磁共振成像检查,颌下腺摘除术中对颌下腺形态进行观察,进行颌下腺走向分析、颌下腺体积测量和病理学检查,并总结其症候群,由此引入颌下腺下垂的概念;对20例OSAS患者摘除下垂的颌下腺,术前行多导睡眠监测(PSG),其中8例行术后PSG,对患者及其家属进行调查和随访,以确定治疗效果。结果:OSAS患者均有颌下腺下垂,即向下移位和肿大;20例患者术前PSG监测睡眠呼吸暂停低通气指数(AHI)最低为28.58次/h,最低SaO2为38%,术后监测8例AHI均在14.90次/h以下,最低SaO2为75%;12例患者阻塞性睡眠呼吸暂停消失,AHI在5次/h以下;8例AHI在10～14.9次/h;8例鼾声消失,12例鼾声存在但减轻,全部患者白天疲劳消除,高血压患者舒张压降至90mmHg以下;随访8～18个月,无一例复发。结论:颌下腺下垂是鼾症可能的并发症,颌下腺下垂使舌根后坠和舌体高拱,同时压迫咽腔通道,最终导致OSAS;鼾症患者的颌下腺下垂是OSAS的主要成因之一,摘除下垂的颌下腺可治愈OSAS。
OBJECTIVE: To study the relationship between submandibular gland in patients with obstructive sleep apnea syndrome (OSAS) and OSAS and the effect of enucleation of such submandibular glands on OSAS. Methods: The submandibular gland of 20 patients with OSAS were examined by the imaging examination including spiral CT scan and magnetic resonance imaging. The morphology of submandibular gland was observed in submandibular gland extirpation. The submandibular gland orientation analysis, submandibular gland volume measurement and pathology examination were summarized. Symptomatic, which led to the concept of submandibular gland prolapse; 20 cases of OSAS patients with submandibular glands drooping, preoperative polysomnography (PSG), including 8 cases of postoperative PSG, the patients and their families were investigated and followed up Determine the effect of treatment. Results: The submandibular gland ptosis, ie, downward shift and enlargement, were found in all patients with OSAS. The lowest PSQ sleep apnea hypopnea index (AHI) was 28.58 times / h and the lowest SaO2 was 38% 8 cases of AHI were 14.90 times / h or less, the lowest SaO2 was 75%; 12 patients obstructive sleep apnea disappeared, AHI at 5 times / h or less; 8 cases of AHI at 10 ~ 14.9 times / h; 8 cases of snoring disappeared , 12 cases of snore exist but reduce, all patients eliminate fatigue during the day, diastolic blood pressure in patients with hypertension dropped to 90mmHg below; followed up for 8 to 18 months, no case of recurrence. Conclusion: The submandibular gland drooping is a possible complication of snoring. Submandibular gland droop causes the tongue base to fall back and the arch of tongue body to arch and simultaneously to cause the pharyngeal channel, finally leading to OSAS. Submandibular gland drooping is one of the major causes of OSAS in snoring patients. Submandibular glands cure OSAS.