Pang Kenny P
Dept. of Otolaryngology, Sleep Disorders Unit, Tan Tock Seng Hospital, Singapore.
J Laryngol Otol. 2005 Apr;119(4):272-6. doi: 10.1258/0022215054020467.
A collapsible airway is often the common denominator in sleep-disordered breathing (SDB). The upper respiratory tract includes the nasal passage, nasopharynx, oral cavity, oropharynx, base-of-tongue region and the hypopharynx. It is believed that the highest amount of resistance in the upper respiratory tract is in the nasal cavities, and particularly the nasal valve. Most authors believe that when considering surgical options for patients with obstructive sleep apnoea (OSA) it is imperative to correct nasal pathology together with the other sites of airway obstruction. In this retrospective study, I sought to investigate the safety and efficacy of one-stage nasal and multi-level pharyngeal surgery. I compared two groups of patients: group 1, receiving one-stage nasal and multi-level pharyngeal surgery; and group 2, receiving only multi-level pharyngeal surgery. In group 1, nine out of 12 patients (75 per cent) met the criteria for surgical success, with a mean pre-operative apnoea-hypopnoea index (AHI) decreasing from 36.3 to 8.9 post-operatively (p<0.0002), while in group 2, 25 out of 40 patients met the surgical success criteria (62.5 per cent), with their mean AHI decreasing from 52.6 to 10.2 (p<0.0000). When comparing the surgical success rates between the two groups, it was not statistically significant, at p>0.106. There were no postoperative respiratory-related complications despite having bilateral nasal Merocel (tampon) packing in place (in group 1), and none of the patients in either group had any desaturation, hypoxaemia, apnoea or OSA-related complications. This series suggests that, with adequate post-operative monitoring, it is both safe and efficacious to perform both nasal and multi-level pharyngeal surgery in the one surgical session.
可塌陷气道通常是睡眠呼吸障碍（SDB）的共同特征。上呼吸道包括鼻腔、鼻咽、口腔、口咽、舌根区域和下咽。据信，上呼吸道中阻力最大的部位是鼻腔，尤其是鼻瓣区。大多数作者认为，在考虑为阻塞性睡眠呼吸暂停（OSA）患者选择手术方案时，纠正鼻腔病变以及气道阻塞的其他部位至关重要。在这项回顾性研究中，我试图探讨一期鼻腔和多级咽部手术的安全性和有效性。我比较了两组患者：第1组接受一期鼻腔和多级咽部手术；第2组仅接受多级咽部手术。在第1组中，12例患者中有9例（75%）达到手术成功标准，术前平均呼吸暂停低通气指数（AHI）从36.3降至术后的8.9（p<0.0002），而在第2组中，40例患者中有25例（62.5%）达到手术成功标准，其平均AHI从52.6降至10.2（p<0.0000）。比较两组的手术成功率时，差异无统计学意义，p>0.106。尽管第1组双侧鼻腔放置了Merocel（棉塞）填塞物，但术后均无呼吸相关并发症，两组患者均未出现任何血氧饱和度下降、低氧血症、呼吸暂停或OSA相关并发症。该系列研究表明，在充分的术后监测下，在同一手术 session 中进行鼻腔和多级咽部手术既安全又有效。
