BACKGROUND: Partial soft palate, uvula and the otiose soft tissue of lateral pharyngeal wall are resected in traditional uvulopalatopharyngoplasty. Although the syndrome can be improved, the complications, such as velopharyngeal insufficiency, cicatricial contration of pharyngeal cavity, can occur in some patients, furthermore, the prostecdtive efficacy is below the mark.OBJECTIVE: To investigate efficacy of the dilatation of oropharyngeal and nasopharyngealisthmus in uvulopalatopharyngoplasty treating obstructive sleep apnea hypopnea syndrome.DESIGN: A case-control observation.SETTING: The Affiliated Municipal Hospital of Medical College, Qingdao University.PARTICIPANTS: The patients who were hospitalized for snoring, apnea, breathing obstruction and somnolence were selected from the Sleep Respiratory Disorder Diagnosis and Treatment Center in the Affiliated Municipal Hospital of Medical College of Qingdao University from July 2001 to February 2006. We ascertained that the obstruction located at pharynx oralis, no hypertrophy of lingual root, and made a definite diagnosis of OSAHS by polysomnogram. The apnea hypopnca index (AHI) was ≥ 5 times per hour. Among 216 patients, there were 159 males and 57 females aged older than 25 years.METHODS: The patients were treated by modified UPPP which maintained the normal anatomic form of pharyngeal cavity, reserved the uvula, performed oblique straight incision along palatoglossal arch to soft palate, and avoided the incision of inverse U type. Palatoplasty and pharyngoplasty could extend the oropharyngeal isthmus and nasopharyngeal isthmus thoroughly.MAIN OUTCOME MEASURES: ① The survey of effect in the near future: Defined the pain without pain-killer as pain lightly, or as pain heavily inversely. If the lateral wall of oropharynx could remain the designed morphous, it was a good henosis; it was a bad henosis inversely. ② The survey of effect in a long term: According to the statement of the patients themselves. Estimated whether the patients had postoperative complications, such as backstreaming in nasal cavity, pharyngeal foreign body sensation, etc. Assessed if the patients had sleep apnea according to the observation of the family member and the monitoring of PSG. And ascertained whether the pharyngeal cavity had approached to normal structure by the examination of oropharynx.RESULTS: All 216 patients were involved in the final analysis. ① Of the 216 subjects, there were 156 patients who needed pain-killer (72%), and 60 Patients need not (26%). The lateral pharyngeal wall of 136 subjects was smooth (63%), and the other 80 were splited partly (37%). There were no complications such as breath holding, backstreaming in the nasal cavity. ② The survey of longdated postoperative effect: The 216 patients were followed up for 6 mouths.There was no deglutitive bucking, open rhinolalia. A total number of 84 patients (39%) had pharyngeal foreign body sensation. The syndrome of sleep apnea disappeared in 169 patients, and the other 47 patients still had the syndrome,but improved than before. In 203 patients (94%), the postoperative morphous of oral cavity were content, and the other 13 patients (6%) were not content. ③ The statistical significance of the preoperative and postoperative result of PSG monitoring of the 216 patients with OSAHS existed and the difference was significant [AI: 35.45±16.42, 12.75±9.62; HI:19.39±9.86, 17.43±10.15; AHI: 54.29±18.13, 28.31 ±16.23; the average low saturation of blood oxygen: (83.58±7.96) %,(85.53±8.18) %; the average saturation of blood oxygen: (91.98±3.29) %, (93.01±3.02) %, P ＜ 0.05].CONCLUSION: The modified uvulopalatopharyngoplasty indicates that this approach not only extend the nasopharynx cavity, but also avoids the postoperative complications. The patients have markedly improved symptoms.

Objective: To compare the efficacy between conventional laryngeal microsurgery and different power CO₂ laser on benign vocal cord lesions for clinical reference. Methods: From June 2016 to December 2018, 580 patients with benign vocal cord lesions admitted to Jiaxing Hospital of Traditional Chinese Medicine were divided into A, B, C, D, E group according to the random number table rule, with 116 cases in each group.A group was treated with conventional laryngeal microsurgery.B, C, D and E groups were treated with CO₂ laser with the output power 2W, 3W, 4W, and 5W.All the patients were tested for phonological parameters (Jitter, Shimmer, F0, MPT, DSI) and Rosent simplified Voice Hand Index (VHI-10). The main vocal parameters and VHI-10 changes were compared among the five groups before surgery and 4 weeks after surgery. Results: Four weeks after operation, Jitter, Shimmer, F0 and DSI of A, B, C, D and E groups decreased with the range B group>C group>D group>E group>A group[(2.42±0.21)% vs.(2.70±0.25)% vs.(2.91±0.31)% vs.(3.24±0.38)% vs.(3.58±0.42)%, F=27.603, P=0.000; (3.86±0.43)% vs.(4.18±0.48)% vs.(4.55±0.56)% vs.(4.87±0.58)% vs.(5.22±0.62)%, F=22.352, P=0.000; (168.50±20.13)Hz vs.(175.24±22.71)Hz vs.(180.65±24.68)Hz vs.(187.28±26.44)Hz vs.(195.55±28.35)Hz, F=18.193, P=0.000; (2.88±0.34) vs.(3.46±0.38) vs.(3.82±0.41) vs.(4.50±0.44) vs.(5.40±0.51), F=31.604, P=0.000]. The MPT of A, B, C, D and E groups were prolonged with the prolongation B group>C group>D group>E group>A group[(16.26±1.69)s vs.(15.65±1.67)s vs.(14.58±1.64)s vs.(13.85±1.60)s vs.(12.61±1.59)s, F=20.415, P=0.000]. Four weeks after operation, VHI-10 in A, B, C, D and E groups decreased with the extents B group>C group>D group>E group>A group[(7.23±0.74)points vs.(9.58±0.95)points vs.(11.48±1.17)points vs.(13.68±1.45)points vs.(15.46±1.74)points, F=27.467, P=0.000]. Conclusion Low-power (2W) CO₂ laser is the best treatment for benign vocal cord lesions, which is worthy of clinical promotion.

Objective:To explore the impact of different family management patterns on the family resilience of children with brain tumors.Methods:A total of 210 parents of children with postoperative brain tumors in 2 tertiary Grade A pediatric hospitals were investigated by the general information questionnaire, family management measure (FaMM) and family resilience rating scale.SPSS 24.0 was used for cluster analysis.Results:(1) Among the scores of FaMM, child identity, condition management ability and parental mutuality were significantly positively correlated with family resilience ( r=0.312, r=0.470, r=0.391, all P<0.05), while view of condition impact, condition management difficulty and condition management effort were negatively correlated with family resilience ( r=-0.346, r=-0.177, r=-0.348, all P<0.05). (2) Family management patterns could be divided into four categories: burden managing (22.9%), effective managing (24.8%), poor managing (28.6%) and tacit managing (23.8%). (3) Family resilience scores of the four patterns were (197.21±20.08), (205.92±14.25), (181.47±18.13) and (198.06±17.08), and their differences were statistically significant ( F=19.498, P<0.01). Conclusion:The family resilience level of children with brain tumor is associated with different family management patterns.Therefore, effective strategies according to different family characteristics should be developed to improve family resilience level.