Lee N R, Givens C D, Wilson J, Robins R B
Medical College of Virginia/Virginia Commonwealth University, Richmond, USA.
J Oral Maxillofac Surg. 1999 Apr;57(4):382-5. doi: 10.1016/s0278-2391(99)90272-0.
The purpose of this study was to investigate the success of a staged surgical reconstruction of the upper airway for treatment of obstructive sleep apnea syndrome.
Thirty-five patients with obstructive sleep apnea syndrome documented by nocturnal polysomnography were treated surgically with a staged protocol for reconstruction of the upper airway. All patients were evaluated preoperatively by a history and physical examination, including fiberoptic nasopharyngoscopy, oropharyngoscopy, and hypopharyngoscopy; cephalometric analysis; and laboratory polysomnography. All patients included were diagnosed with type II obstruction, with collapse at the oropharyngeal and hypopharyngeal levels. Stage I reconstruction consisted of uvulopalatopharyngoplasty (UPPP) by the Fujita method and anterior mandibular osteotomy (AMO) or inferior sagittal osteotomy (ISO) with genioglossus muscle advancement. If stage I was unsuccessful, patients were advanced to stage II and stage III, if necessary. Stage II reconstruction consisted of bimaxillary advancement with rigid fixation. Stage III reconstruction consisted of hyoid myotomy and advancement.
All patients underwent follow-up nocturnal polysomnography 4 to 6 months after the last surgical procedure. Most patients responded positively to stage I reconstruction (respiratory disturbance index [RDI] < 20, with O2 saturation 95+%). Twenty-four patients (69%) had postoperative RDIs of 20 or less. Of these, 11 patients (31%) had an RDI of five or fewer; seven patients (20%) had an RDI between 6 and 10, and six patients (17%) had an RDI between 10 and 20. The mean preoperative RDI was 53, and the mean postoperative RDI was 19. Of the three patients who elected to proceed to stage II reconstruction, all had a postoperative RDI of 10 or less (two patients [67%] had an RDI of 5 or less, and one patient [33%] had an RDI of 6 to 10).
This study showed that properly selected patients with obstructive sleep apnea syndrome benefit from a staged reconstruction of the upper airway.
本研究旨在探讨分期手术重建上气道治疗阻塞性睡眠呼吸暂停综合征的成功率。
35例经夜间多导睡眠图记录的阻塞性睡眠呼吸暂停综合征患者接受了分期上气道重建手术方案治疗。所有患者术前均通过病史及体格检查进行评估，包括纤维鼻咽喉镜检查、口咽喉镜检查；头影测量分析；以及实验室多导睡眠图检查。所有纳入患者均诊断为II型阻塞，口咽和下咽水平存在塌陷。I期重建包括采用藤田法行悬雍垂腭咽成形术（UPPP）以及下颌前截骨术（AMO）或下颌下矢状截骨术（ISO）并前移颏舌肌。若I期手术失败，必要时患者进入II期和III期手术。II期重建包括采用坚固内固定的双颌前移。III期重建包括舌骨肌切开术及前移。
所有患者在最后一次手术后4至6个月接受了随访夜间多导睡眠图检查。大多数患者对I期重建反应良好（呼吸紊乱指数[RDI]<20，血氧饱和度95%以上）。24例患者（69%）术后RDI为20或更低。其中，11例患者（31%）RDI为5或更低；7例患者（20%）RDI在6至10之间，6例患者（17%）RDI在10至20之间。术前平均RDI为53，术后平均RDI为19。在选择进行II期重建的3例患者中，所有患者术后RDI均为10或更低（2例患者[67%]RDI为5或更低，1例患者[33%]RDI在6至10之间）。
本研究表明，经适当选择的阻塞性睡眠呼吸暂停综合征患者可从分期上气道重建中获益。
