Berger G, Finkelstein Y, Stein G, Ophir D
Department of Otolaryngology-Head and Neck Surgery, Meir General Hospital, Sapir Medical Center, Kfar Saba 44281, Israel.
Arch Otolaryngol Head Neck Surg. 2001 Apr;127(4):412-7. doi: 10.1001/archotol.127.4.412.
To assess the subjective and objective medium- to long-term results of laser-assisted uvulopalatoplasty for snoring.
A nonrandomized, prospective, before-after trial.
Fourteen patients underwent laser-assisted uvulopalatoplasty surgery; 2 surgical techniques, which differ with respect to the mode of midline palatal vaporization, were used.
Subjective analysis included a preoperative and 2 postoperative evaluations of the state of snoring: 4 weeks and 10.1 +/- 7.9 months (mean +/- SD) after completion of last laser treatment. In addition, a score on 5 other sleep-related symptoms was recorded before treatment and after 10.1 +/- 7.9 months; at that time, patients also estimated their overall satisfaction with the procedure. Objective analysis included preoperative nocturnal polysomnographic studies that were repeated postoperatively.
A decline in snoring improvement from 79% (11/14) to 57% (8/14) was recorded; furthermore, state of snoring worsened from 7% (1/14) to 21% (3/14). Likewise, reevaluation of the 5 other sleep-related symptoms at the final follow-up visit uncovered a 57% improvement rate. Overall satisfaction with the procedure was 43%. The results of the postoperative objective studies corresponded to those of the subjective ones and demonstrated significant worsening of respiratory disturbance index in 3 (21%) of the 14 patients, who became mildly apneic. These findings were encountered with both laser techniques.
The favorable subjective short-term results of laser-assisted uvulopalatoplasty deteriorated with time. In addition, postoperative nocturnal polysomnography showed that the procedure caused mild obstructive sleep apnea in a considerable number of patients who formerly were nonapneic snorers. These findings may be related to velopharyngeal narrowing and progressive palatal fibrosis, caused by the thermal damage inflicted by the laser beam.
评估激光辅助悬雍垂腭咽成形术治疗打鼾的主观和客观中长期效果。
一项非随机、前瞻性、前后对照试验。
14例患者接受了激光辅助悬雍垂腭咽成形术；采用了2种手术技术，这两种技术在腭部中线汽化方式上有所不同。
主观分析包括术前及术后2次对打鼾状况的评估：最后一次激光治疗结束后4周以及10.1±7.9个月（均值±标准差）。此外，记录治疗前及10.1±7.9个月后另外5种与睡眠相关症状的评分；此时，患者还需对手术的总体满意度进行评估。客观分析包括术前夜间多导睡眠图研究，术后重复进行。
打鼾改善率从79%（11/14）降至57%（8/14）；此外，打鼾状况恶化的比例从7%（1/14）增至21%（3/14）。同样，在最后一次随访时对另外5种与睡眠相关症状的重新评估显示改善率为57%。手术总体满意度为43%。术后客观研究结果与主观结果一致，14例患者中有3例（21%）呼吸紊乱指数显著恶化，出现轻度呼吸暂停。两种激光技术均出现了这些结果。
激光辅助悬雍垂腭咽成形术良好的主观短期效果随时间推移而恶化。此外，术后夜间多导睡眠图显示，该手术在相当数量既往无呼吸暂停的打鼾患者中导致了轻度阻塞性睡眠呼吸暂停。这些发现可能与激光束造成的热损伤引起的腭咽狭窄和渐进性腭部纤维化有关。
