口蓋垂軟口蓋咽頭形成術施行上の問題点

Clinical Problems in Uvulopalatopharyngoplasty

　はじめに

　口蓋垂軟口蓋咽頭形成術（Uvulopalatopharyn-goplasty，以下UPPP）^1）は，閉塞性睡眠時無呼吸症候群（Obstructive sleep apnea syndrome，以下OSAS）あるいはいびき症に対して有効な手術法と考えられている。一方，OSASの臨床的特徴としては，中咽頭が狭く，舌が大きいといった局所の解剖学的要因と，肥満，心肥大，不整脈，高血圧，多血症，糖尿病といった合併症を伴った全身的な要因が挙げられる。こうした局所的，全身的な要因はしばしば手術および麻酔のリスクファクターとなる。今回，咽頭腔の拡大を目的としてUPPPを施行したOSAS，およびいびき症についての臨床的特徴を検討し，全身麻酔下におけるUPPP施行上の問題点について考察を行ったので報告する。

A retrospective study was conducted on 58 cases who had undergone uvulopalatopharyngoplasty (UPPP) for snoring and obstructive sleep apnea syndrome (OSAS) with special regards to their preoperative findings and postoperative results. It was noted that 25 out of the 58 cases were diagnosed to have systemic diseases of slight to severe degree preoperatively. In 25 cases, intratracheal intubation for general anesthesia was difficult, and surgical procedure was particularly difficult in 10 cases mainly due to a narrowing of the pharyngeal lumen. For those cases in which difficulty in intubation was expected, a preoperative consultation with anesth-esiologist seemed to be mandatory. In postoperative evaluation of surgical effects, the degree of subjec-tive satisfaction of the patient and the result of objective tests including sleep study should be taken into consideration.