超快速核磁共振成像（Ultrafast MR Imaging）在阻塞性睡眠呼吸暂停综合征阻塞部位判定中的临床意义
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摘要
目的 通过超快速磁共振成像（Ultrafast magnetic resonance imaging，超快速MRI）对阻塞性睡眠呼吸暂停综合症（obstructive sleep apnea syndrome，OSAS）阻塞部位进行定位研究，并探讨将两种方法联合应用以提高改良UPPP手术疗效。
方法 对16例患者术前术后行PSG、MRI、FNMN及各径线测量，然后对其中的15例进行手术。分别对其术前术后结果进行分析。
结果（1）使用超快速MRI筛选改良PPP适应证病例，，阻塞部位位于SP，手术获得满意疗效；阻塞位于SP+LP+EP者，手术疗效较差。（2）16例行两种检查的患者，13例二者检查结果一致。另外其余3例患者，2例在FNMN检查示SP阻塞，而MR显示有SP+LP阻塞；1例FNMN示SP+LP+EP均有阻塞，而MRI示EP并未阻塞。经相关回归分析证实：两种检查结果具有相关性。（3）LP与EP阻塞在术后均有不同程度的减轻。
结论 应用超快速MRI对改良PPP手术患者进行筛选，可提高手术疗效，对确定诊疗措施有一定指导意义。
Objective We attempted to determine the usefulness of Ultrafast MR Imaging examination in positioning the obstructive sites in patients with OSAS.
Methods A total of 16 patients with OSAS underwent Ultrafast MR Imaging examination, while after i.v. injection of hydroxyzine hydrochloride. Serial imagines of 15 patients were examined before and after UPPP. Pharyngeal finding on MRI were divided into: (1)Soft Palate level,SP or Velopharynx level, (2) Lingual Root level，LR or Glosspharynx level,(3) Epiglottis level，EP. PSG findings were analyzed to determine the severity of obstructive sleep apnea as evaluated by AHI and the lowest SaO2 value during sleep. We also used fiberoptic nasopharyngoscopy with Muller's maneuver，FNMN before and after surgical method and compared the findings with Ultrafast MR Imaging examination.
Results (1)UPPP succeeded when MRI findings showed the obstructive sites in SP ,while in SP+LP or SP+LP+EP, UPPP was less useful. (2)Compared with findings in MRI imagines and FNMN, we found therewere corresponds between them.
Conclusion Analysis of pharyngeal dynamics using Ultrafast MR Imaging may provide some useful information for promoting the successful rate of UPPP.
方法 对16例患者术前术后行PSG、MRI、FNMN及各径线测量，然后对其中的15例进行手术。分别对其术前术后结果进行分析。
结果（1）使用超快速MRI筛选改良PPP适应证病例，，阻塞部位位于SP，手术获得满意疗效；阻塞位于SP+LP+EP者，手术疗效较差。（2）16例行两种检查的患者，13例二者检查结果一致。另外其余3例患者，2例在FNMN检查示SP阻塞，而MR显示有SP+LP阻塞；1例FNMN示SP+LP+EP均有阻塞，而MRI示EP并未阻塞。经相关回归分析证实：两种检查结果具有相关性。（3）LP与EP阻塞在术后均有不同程度的减轻。
结论 应用超快速MRI对改良PPP手术患者进行筛选，可提高手术疗效，对确定诊疗措施有一定指导意义。
Objective We attempted to determine the usefulness of Ultrafast MR Imaging examination in positioning the obstructive sites in patients with OSAS.
Methods A total of 16 patients with OSAS underwent Ultrafast MR Imaging examination, while after i.v. injection of hydroxyzine hydrochloride. Serial imagines of 15 patients were examined before and after UPPP. Pharyngeal finding on MRI were divided into: (1)Soft Palate level,SP or Velopharynx level, (2) Lingual Root level，LR or Glosspharynx level,(3) Epiglottis level，EP. PSG findings were analyzed to determine the severity of obstructive sleep apnea as evaluated by AHI and the lowest SaO2 value during sleep. We also used fiberoptic nasopharyngoscopy with Muller's maneuver，FNMN before and after surgical method and compared the findings with Ultrafast MR Imaging examination.
Results (1)UPPP succeeded when MRI findings showed the obstructive sites in SP ,while in SP+LP or SP+LP+EP, UPPP was less useful. (2)Compared with findings in MRI imagines and FNMN, we found there
Conclusion Analysis of pharyngeal dynamics using Ultrafast MR Imaging may provide some useful information for promoting the successful rate of UPPP.
引文
1. 黄席珍，吴全有，李龙云等．多导睡眠图的应用．中华内科杂志，1991,30(12)：758
2. Young T，Palta M，Dempsey，et al．Ｔhe occurrence of sleep-disordered breathing among middle-aged adults．N．Engl．Ｊ．Med．1993,328(17)：1230
3. Phillipson EA．Sleep Apnea-a major public health problem．N．Engl．Ｊ．Med．1993,328(17)：1271
4. Stradling JR. Obstructive sleep apnea: definitions, epidemiology, and natural history. Thorax 1995; 50: 683-89.
5. Isono S, Remmers JE. Anatomy and physiology of upper airway obstruction. In: Kryger MH, ed. Principles and practice of sleep apnea medicine. 2nd. Philadelphia: Saunders, 1994. 642-656
6. Leiter JC. Upper airway shape : is it important in the pathogenesis of obstructive sleep apnea? Am J Respir Crit Care Med, 1996, 153: 894-898
7. Meiljetaig H, Mataiks S, Haight JS, et al. Subjective and objective assessment of uvulopalatopharyngoplasty for trement of soring and sleep apnea. Am J Respir Crit Care Med, 1994, 150: 1286--1290
8. Suto Y, matsuo T, Hori I, et al. Evaluation of the pharyngeal airway in patients with sleep apnea: value of ultrafast MR imaging. AJR, 1993, 160: 311-314
9. Launois SH, Feroah WN, Campbell FG,et al. Site of pharyngeal narrowing predicts outcome of surgery for obstructive sleep apnea. Am Rev Respir Dis. 1993,147; 182-189
10. Aboussouan LS, Golish JA, Wood BG, et al. Dynamicpharyngoscopy in predicting outcome of uvulopalatopharyngoplasty for moderate and severe obstructive sleep apnea. Chest. 1995, 107:946--951
11. Borowiecki B, Sassin J. Surgical treatment of sleep apnea. Arch Otolaryngol. 1983; 109--508.
12. Sher AE,Shprintzen RJ, Thorpy MJ. Endoscopic observation of obstructive sleep apnea in children with anomalous upper airway:Predictive and therapeutic value. Inter J Pediat Otorhinolaryngol. 1986; 11(2):135
13. Suto Y, Inoue Y. Sleep apnea syndrome: Examination of pharyngeal obstruction with high-speed MR and polysomnography. Acta Radiologica. 1996 : 37 315-320
14. Petri N, Suadicani P, Wildschiodtz G, et al. Predictive value of Muller maneuver ,cephalometry and clinical features for the outcome of uvulopalatopharyngoplasty. Acta Otolaryngol, 1994; 114:565-571
15. 叶京英，韩德民，张永杰等。 阻塞性睡眠呼吸暂停综合征患者上气道的形态学研究 中华耳鼻咽喉科杂志 2000 08 07；35（4）： 278-281
16. Katsantonis PG, Mass CS, Walsh JK. The predictive efficacy of the muller maneuver in uvulopalatopharyngoplasty. Laryngoscope, 1989; 99:677
17. 刘月华，曾祥龙， 傅民魁等。 不同颅面型的阻塞性睡眠呼吸暂停综合征患者睡眠呼吸障碍严重程度的比较研究 临床口腔医学杂志 1998.02 .20；14（1）：20-21
18. 李巍然，James P McDonald.下颌前移矫正器对阻塞性睡眠呼吸暂停综合征患者上气道影响的X线研究。 口腔正畸学 2000. 09. 15；7（3）：111-114
19. Schwab RJ. Upper airway imaging. Clin Chest Med. 1998 Mar;19(1) : 33-54
20. Avrahami E, Englender M. Relation between CT axial cross-sectional area of the oropharynx and obstrutive sleep apnea syndrome in adults. A JNR Am J Neuroradiol. 1995 Jan ; 16(1): 135-140
21. Miro Castillo N, Roca Ribas Serda F, Quesada Martinez JL ,et al. Morphological comparative imaging study of the pharynx in patients with obstructive sleep apnea syndrome (OSAS), healthy snorers and controls. Acta Otorrinolaringol Esp. 1998 Jan-Feb; 49(1): 34-40
22. Caballero P，Alvarez Sala R，Garcia Rio F. CT in the evaluation of the upper airway in healthy subjects and in patients with obstrutive sleep apnea syndrome. Chest, 1998 Jan; 113(1) :111-116
23. Jager L, Gunther E, Gauger J, et al. Functional MRI of the pharynx in obstructive sleep apnea using rapid 2D FLASH sequences. Radiologe. 1996 Mar; 36(3):245-53
24. Okada T, Fukatsu H, Ishigaki T, et al. Ultra low field magnetic resonance imaging in upper airways obstruction in sleep apnea syndrome. Psychiatry Clin Neurosci. 1996 Oct;
50(5): 285-9
25. Suto Y, Inoue Y. Sleep apnea syndrome: Examination of pharyngeal obstruction with high-speed MR and polysomnography. Acta Radiologica. 1996 : 37 315-320
26 . 高雪梅 曾祥龙 傅民魁 阻塞性睡眠呼吸暂停综合征上气 道阻塞点的磁共振研究 现代口腔医学杂志 2000. 05 .19 ；14（3）：185-187
27. 张连山，魏伯俊，王轶. 重症阻塞性睡眠呼吸暂停综合怔术前预防性气管切开的适应症. 中华耳鼻咽喉科杂志 1995.06.10；30（3）：138-139
28. Hultcrantz E, Linder A, Markstrom A. Tonsillectomy or tonsillotomy? - A randomized study comparing postoperative pain and long_term effects. Int-J-Pediatr-Otorhinolaryngol. 1999 Dec 15; 51(3): 171--176
29. Fujita s, Conway WA, Zeric FJ, et al. Surgical correction of anatomic abnormalities of obstructive sleep anpea syndrome: uvulopalatopharyngoplasty. Otolarynol Head Neck Surg 1981,89:923-934.
30. Simmons FB, Guilleminaule C, Silvestri R. Snoring, and Some obstructive sleep apnea, can be cured by orophargngeal Surgerg. Arch Otolaryngol, 1983, 109:503.
31. Morar WB, Orr WC. Diagnosis and management of obstructive sleep apnea. Arch Otolaryngol , 1985,111:650.
32. 孙炜，李娜，鞠建宝等。改良腭咽成形术治疗鼾症30例报告，临床耳鼻咽喉杂志，1994，8：74-75。
33. Levin BC, Becker GD. Uvulopalatopharyngoplasty for snoring:long-term results. Laryngoscope, 1994;104:1150-1152
34. Riley RW, Powell NB, Guilleminault C. Obstructive sleep apnea syndrome: A review of 306 consecutively treated surgical patient. Otolaryngol Head Neck Surg,1993;108:117-125
35 . Fujita s, Conway WA, Zeric FJ, et al. Evaluation of the affectiveness of UPPP . Laryngoscope, 1985; 95: 70-74
36. 韩德民，王军，叶高英等，腭咽成形术中保留悬雍垂的意义，中华耳鼻咽喉科杂志。2000，35：215-218。
37. 伊彪 ，张熙恩，张震康：正颌外科治疗阻塞性睡眠呼吸暂停综合征 中华口腔医学杂志 1997 03 25；32（2）：114-117
38. Li KK, Riley RW, Powell NB, et al. Postoperative airway findings after maxillomandibular advancement for obstructive sleep apnea syndrome. Laryngoscope. 2000 Feb; 110(2 Pt 1):325-327
39.RileyR, Powen N, Guilleminaultc. Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical Patients . Otolaryngol Head Neck Surg 1993,108:117-125.
40 . 林立群，林其风，陈宁等. 高位颏前徙术加悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停综合征 口腔医学纵横 2000.08.31；16（3）： 212-214
2. Young T，Palta M，Dempsey，et al．Ｔhe occurrence of sleep-disordered breathing among middle-aged adults．N．Engl．Ｊ．Med．1993,328(17)：1230
3. Phillipson EA．Sleep Apnea-a major public health problem．N．Engl．Ｊ．Med．1993,328(17)：1271
4. Stradling JR. Obstructive sleep apnea: definitions, epidemiology, and natural history. Thorax 1995; 50: 683-89.
5. Isono S, Remmers JE. Anatomy and physiology of upper airway obstruction. In: Kryger MH, ed. Principles and practice of sleep apnea medicine. 2nd. Philadelphia: Saunders, 1994. 642-656
6. Leiter JC. Upper airway shape : is it important in the pathogenesis of obstructive sleep apnea? Am J Respir Crit Care Med, 1996, 153: 894-898
7. Meiljetaig H, Mataiks S, Haight JS, et al. Subjective and objective assessment of uvulopalatopharyngoplasty for trement of soring and sleep apnea. Am J Respir Crit Care Med, 1994, 150: 1286--1290
8. Suto Y, matsuo T, Hori I, et al. Evaluation of the pharyngeal airway in patients with sleep apnea: value of ultrafast MR imaging. AJR, 1993, 160: 311-314
9. Launois SH, Feroah WN, Campbell FG,et al. Site of pharyngeal narrowing predicts outcome of surgery for obstructive sleep apnea. Am Rev Respir Dis. 1993,147; 182-189
10. Aboussouan LS, Golish JA, Wood BG, et al. Dynamic
11. Borowiecki B, Sassin J. Surgical treatment of sleep apnea. Arch Otolaryngol. 1983; 109--508.
12. Sher AE,Shprintzen RJ, Thorpy MJ. Endoscopic observation of obstructive sleep apnea in children with anomalous upper airway:Predictive and therapeutic value. Inter J Pediat Otorhinolaryngol. 1986; 11(2):135
13. Suto Y, Inoue Y. Sleep apnea syndrome: Examination of pharyngeal obstruction with high-speed MR and polysomnography. Acta Radiologica. 1996 : 37 315-320
14. Petri N, Suadicani P, Wildschiodtz G, et al. Predictive value of Muller maneuver ,cephalometry and clinical features for the outcome of uvulopalatopharyngoplasty. Acta Otolaryngol, 1994; 114:565-571
15. 叶京英，韩德民，张永杰等。 阻塞性睡眠呼吸暂停综合征患者上气道的形态学研究 中华耳鼻咽喉科杂志 2000 08 07；35（4）： 278-281
16. Katsantonis PG, Mass CS, Walsh JK. The predictive efficacy of the muller maneuver in uvulopalatopharyngoplasty. Laryngoscope, 1989; 99:677
17. 刘月华，曾祥龙， 傅民魁等。 不同颅面型的阻塞性睡眠呼吸暂停综合征患者睡眠呼吸障碍严重程度的比较研究 临床口腔医学杂志 1998.02 .20；14（1）：20-21
18. 李巍然，James P McDonald.下颌前移矫正器对阻塞性睡眠呼吸暂停综合征患者上气道影响的X线研究。 口腔正畸学 2000. 09. 15；7（3）：111-114
19. Schwab RJ. Upper airway imaging. Clin Chest Med. 1998 Mar;
20. Avrahami E, Englender M. Relation between CT axial cross-sectional area of the oropharynx and obstrutive sleep apnea syndrome in adults. A JNR Am J Neuroradiol. 1995 Jan ; 16(1): 135-140
21. Miro Castillo N, Roca Ribas Serda F, Quesada Martinez JL ,et al. Morphological comparative imaging study of the pharynx in patients with obstructive sleep apnea syndrome (OSAS), healthy snorers and controls. Acta Otorrinolaringol Esp. 1998 Jan-Feb; 49(1): 34-40
22. Caballero P，Alvarez Sala R，Garcia Rio F. CT in the evaluation of the upper airway in healthy subjects and in patients with obstrutive sleep apnea syndrome. Chest, 1998 Jan; 113(1) :111-116
23. Jager L, Gunther E, Gauger J, et al. Functional MRI of the pharynx in obstructive sleep apnea using rapid 2D FLASH sequences. Radiologe. 1996 Mar; 36(3):245-53
24. Okada T, Fukatsu H, Ishigaki T, et al. Ultra low field magnetic resonance imaging in upper airways obstruction in sleep apnea syndrome. Psychiatry Clin Neurosci. 1996 Oct;
50(5): 285-9
25. Suto Y, Inoue Y. Sleep apnea syndrome: Examination of pharyngeal obstruction with high-speed MR and polysomnography. Acta Radiologica. 1996 : 37 315-320
26 . 高雪梅 曾祥龙 傅民魁 阻塞性睡眠呼吸暂停综合征上气 道阻塞点的磁共振研究 现代口腔医学杂志 2000. 05 .19 ；14（3）：185-187
27. 张连山，魏伯俊，王轶. 重症阻塞性睡眠呼吸暂停综合怔术前预防性气管切开的适应症. 中华耳鼻咽喉科杂志 1995.06.10；30（3）：138-139
29. Fujita s, Conway WA, Zeric FJ, et al. Surgical correction of anatomic abnormalities of obstructive sleep anpea syndrome: uvulopalatopharyngoplasty. Otolarynol Head Neck Surg 1981,89:923-934.
30. Simmons FB, Guilleminaule C, Silvestri R. Snoring, and Some obstructive sleep apnea, can be cured by orophargngeal Surgerg. Arch Otolaryngol, 1983, 109:503.
31. Morar WB, Orr WC. Diagnosis and management of obstructive sleep apnea. Arch Otolaryngol , 1985,111:650.
32. 孙炜，李娜，鞠建宝等。改良腭咽成形术治疗鼾症30例报告，临床耳鼻咽喉杂志，1994，8：74-75。
33. Levin BC, Becker GD. Uvulopalatopharyngoplasty for snoring:long-term results. Laryngoscope, 1994;104:1150-1152
34. Riley RW, Powell NB, Guilleminault C. Obstructive sleep apnea syndrome: A review of 306 consecutively treated surgical patient. Otolaryngol Head Neck Surg,1993;108:117-125
35 . Fujita s, Conway WA, Zeric FJ, et al. Evaluation of the affectiveness of UPPP . Laryngoscope, 1985; 95: 70-74
36. 韩德民，王军，叶高英等，腭咽成形术中保留悬雍垂的意义，中华耳鼻咽喉科杂志。2000，35：215-218。
37. 伊彪 ，张熙恩，张震康：正颌外科治疗阻塞性睡眠呼吸暂停综合征 中华口腔医学杂志 1997 03 25；32（2）：114-117
38. Li KK, Riley RW, Powell NB, et al. Postoperative airway findings after maxillomandibular advancement for obstructive sleep apnea syndrome. Laryngoscope. 2000 Feb; 110(2 Pt 1):325-327
39
40 . 林立群，林其风，陈宁等. 高位颏前徙术加悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停综合征 口腔医学纵横 2000.08.31；16（3）： 212-214