中文摘要：

目的腭咽是阻塞性睡眠呼吸暂停（obstructive sleep apnea,OSA）患者中最为常见的阻塞部位,该类患者手术治疗多采用保留悬雍垂腭咽成形术（Han-uvulopalatopharyngoplasty,H-UPPP）,切除扁桃体是该手术的重要组成部分,其目的是扩大咽腔,改善气道通气性能。手术后切口缝合时会引起组织中应力重新分布,从而直接影响术后咽腔壁的几何形态和手术效果。但目前尚无有效方法评估切口缝合方式对手术效果的影响。本研究提出利用有限元分析模型探究扁桃体窝不同缝合方式对咽腔结构的影响,以此对H-UPPP术式操作的选择提供理论依据。方法基于OSA患者头颈部磁共振图像,构建具有真实解剖结构的气道及周边组织的三维有限元模型。通过收缩扁桃体组织体积和限定其组织表面位移来模拟扁桃体切除手术及三种缝合方式。利用ADINA软件进行数值模拟,通过观察气道最小横截面面积和咽腔空间的变化等探讨不同缝合方式对咽腔尺度的影响。结果利用三维有限元模型模拟了对位、前拉、后拉三种缝合方式。数值模拟结果显示,前拉缝合扁桃体窝时气道最狭窄处横截面积变化最为显著,扩大了27.82%。而对位缝合和后拉缝合扁桃体窝的情况,该处横截面积增加量分别为24.76%和27.11%。对于对位和后拉缝合,悬雍垂游离端附近的咽腔横截面积变化更为明显,其平均值约为手术前的5倍。相比之下,前拉缝合后相同区域平均咽腔横截面积值约为手术前的4.3倍。结论腭咽成形术改良术式的伤口缝合方式会对周边软组织中应力分布和气道截面几何形态产生重要影响。本研究建立的方法可用于针对不同患者的个性化模拟,对于本研究所涉的患者上气道解剖结构类型,模型显示前拉缝合对改善患者咽腔最狭窄部位结构更为有利。

英文摘要：

Objective Palatopharynx is the most common area for upper airway obstructions in obstructive sleep apnea（ OSA） patients. One of the most popular surgical treatments for these patients is the Hanuvulopalatopharyngoplasty（ H-UPPP）. As an important part of the surgery,tonsils are removed to enlarge thepharyngeal airway and improve the ventilation. The suture after a surgery can change the stress distribution in the surrounding tissues, which may directly affect the geometry of the pharyngeal wall and surgery results. However,there are currently no effective simulation methods that can be used to evaluate the effects of suture selections on surgery results. In this study,we develop a new finite element model to analyze the effects of different selections for tonsillar fossa suturing on the pharyngeal structure,which can provide theoretical references for suture selections in H-UPPP surgeries. Methods Based on magnetic resonance images of the head and neck for an OSA patient,we built an anatomically realistic three-dimensional mechanical and finite element model of the upper airway with surrounding tissues. By shrinking the volume representing tonsils in the model and limiting the displacements of its certain surfaces,we simulated the surgery with three different suture schemes. The numerical simulations were performed by using the software ADINA. By observing the changes in the narrowest cross section of the airway and the pharyngeal space,we evaluated the effects of different suture selections on the size of the pharyngeal airway. Results Using the three-dimensional finite element model,we simulated the three suture selections： the interrupted suture,the pulling-forward suture,and the pullingbackward suture. The numerical results showed that in the case of a pulling-forward suture for the tonsillar fossa,there was a 27. 82% increase in the cross-sectional area at the narrowest part of the upper airway,which was larger than 24. 76% for an interrupted suture and 27. 11% for a pulling-forward suture. However,