UPPP surgery

UPPP surgery was initiated in 1981 by Fujita. It has been improved by scholars at home and abroad and is still the main surgical treatment for snoring and OSAS. UPPP can enlarge the pharyngeal cavity and remove the posterior occlusion of the sacral cavity by excising part of the hypertrophic soft palate tissue, sag, excess soft tissue of the pharyngeal wall and hypertrophic sputum tonsil. At the beginning of the operation (1981-1982), the success rate was about 75%. The success rate reported in the literature was lower. The PSG test was used, and the AHI decreased by 50% as the effective standard. Janson followed up patients 4 to 8 years after UPPP and confirmed that the long-term effect of HI pharyngoplasty with AHI 40 can reach 65%. The effect of pharyngeal pharyngoplasty is related to the patient's body mass index, and the body mass index is small. In younger patients, the curative effect is better than that of obese and elderly patients. Because obese people are caused by redeposition of soft palate adipose tissue, elderly patients are due to upper airway enlargement muscle relaxation. Hagert (1999) conducted a questionnaire survey of snoring and daytime sleep conditions for patients and their cohabitants 1 to 8 years after snoring. Among them, 255 were preoperatively diagnosed with habitual snoring, 110 were OSAS and 48 were non-specific snoring, and 345 were cohabiting with snoring patients. The age of the patients was 20-70 years old, and the follow-up time was 16-97 months. , an average of 40 months. There were 292 cases of UPPP and 121 cases of LAUP. The results showed that the difference in the type of snoring and the gender of the patient were not related to the curative effect. 89.6% of the patients and 92% of the cohabitees confirmed that the incidence of snoring was improved after surgery. In patients who did not improve, the incidence of snoring was related to the type of surgery and the time after surgery. The shorter the postoperative time, the better the surgical outcome. 73.3% of patients and 67% of cohabitants reported that patients still had mild sleepiness during the day. Of the 415 patients who underwent surgery, 18% had no more snoring and 25% had no daytime sleepiness. Moreover, the survey also showed that pharyngeal pharyngoplasty was significantly better than LAUP. Although the long-term (more than 2 years) effect of pharyngeal pharyngoplasty is lower than the short-term effect. However, the effect of pharyngeal pharyngoplasty on relieving the patient's snoring and lethargy should be affirmative. Because the efficacy of UPPP is not ideal, and the risk of intraoperative and postoperative is large, there are cases of death caused by UPPP in domestic and foreign literatures. Therefore, in the popularization of pharyngeal pharyngoplasty, emphasis should be placed on snoring and The importance of preoperative PSG in OSAS patients, CPCP and selective tracheotomy should be performed before and after surgery for patients with severe OSAS and severe hypoxemia. In addition, surgical planning should consider multi-planar combination therapy. Treatment of diseases: snoring Indication UPPP surgery is suitable for: 1. In patients with simple snoring, the snoring affects those who sleep in the same room or who require surgery for occupational reasons. 2. Patients under the age of 60 who were judged to have mild or moderate OSAS by PSG. 3. After the positioning examination, it is confirmed that the upper airway obstruction site is in the posterior plane of the soft palate. Contraindications 1.SAS is a central or mixed type. 2. Severe OSAS patients with severe comorbidities. 3. Morbid obesity. 4. There are small jaw or jaw retraction deformity. Preoperative preparation 1. Must have PSG analysis results. 2. The positioning diagnosis of the blocking plane must be clarified. 3. Keep the mouth clean before surgery, treat oral diseases, and gargle with 0.02% furancillin solution. 4. Prepare for preoperative preparation according to the requirements of general anesthesia. Do not use sedative as much as possible before surgery. Surgical procedure First, the length of the soft palate should be estimated. The soft palate is pushed back with the tongue depressor, and the soft palate and posterior pharyngeal wall contact points are defined as the boundary of the soft palate. 1. Incision: The mucosa was cut from the root of the tongue and the arch, 0.5 cm along the outer edge of the tongue and arch, and cut into a soft palate in an arc. The incision line was moved outward by 0.5 cm, and the incision edge was inwardly cut. Cut the mucosa at the junction of the pharyngeal arch and the tonsil. 2. Peel off the tonsils. 3. From the lingual arch, soft palate and pharyngeal arch, make a sharp peel of the mucosa and submucosal tissue, retain the muscle tissue, cut off the soft palate part of the proposed resection, but should retain some soft nasopharyngeal mucosa. 4. Grab the velopharyngeal muscles in the medial 1/3 and pull them with 3-0 absorbable sutures, and suture them to the genioglossus muscles; Pull the sacral bow and close the tonsil socket. 5. The soft palate mucosa is referred to the oral side from the nasopharynx side and sutured with a 4-0 absorbable suture. Remove the excess soft palate mucosa, but make the mucosa completely cover the wound without leaving the bare part. 6. Discrete the sag and long sag as appropriate; in principle, the sag is reserved. If it is too long, it can be partially removed. 7. If there is excessive mucosa in the posterior pharyngeal wall, a semi-circular incision can be made outside the posterior pharyngeal wall to remove excess mucosa. 8. Separate the mucosa on the inside of the margin and pull it outward and suture the mucosa on the outside of the margin.