Babiński Dariusz, Stankiewicz Czesław, Kowalska Bozena, Majkowicz Mikołaj
Klinika Chorób Uszu, Nosa, Gardła i Krtani AM w Gdańsku.
Otolaryngol Pol. 2007;61(3):295-300. doi: 10.1016/S0030-6657(07)70429-8.
Surgical treatment of OSAS is focused on removal of narrowing that increase airway resistance in upper respiratory tract. Nd:YAG laser beam penetrates deeper into tissue than CO2 laser followed by superior scarification ability. In this study we investigate efficacy of surgery with Nd:YAG laser assisted uvuloplasty (LAUP).
The subject was 51 patients with OSAS treated in Department of Otolaryngology, Medical University of Gdansk during the 2004-2005 period. All patients underwent all-night PSG and the ESS (Epworth Sleepiness Scale) score was used to assess the daytime sleepiness. Surgery treatment was performed and all patients underwent LAUP and additionally lingual base laser vaporization, tonsillectomy and nasal surgery where needed. The postoperative control ENT examination including ESS and all-night PSG was performed after 6 months.
Success was found in 29 patients, they achieved AHI<10 and ESS<12. In another 22 patients improvement at PSG parameters and ESS score were evaluated but they were still beyond normal range. Success was obtained in 14/16 patients with preoperative AHI I degree, 10/19 AHI II, and 4/16 AHI III. Nasal surgery for enlargement of airway passage was performed more frequently (25/32) in the group with success then in the group with partial improvement (9/19). Preoperative PSG parameters were better in patients with nasal obstruction. Patients with BMI> or =30 succeeded rarely (10/22) in compare with patients with BMI<30 (success in 24/29). Preoperative PSG parameters were better in patients with BMI<30.
LAUP with Nd:YAG laser wit additional tonsillectomy, lingual base surgery and nasal surgery were needed is successful method for surgery at light and medium stage of OSAS in nonobese patients.
阻塞性睡眠呼吸暂停综合征（OSAS）的外科治疗重点在于消除上呼吸道中增加气道阻力的狭窄部位。钕钇铝石榴石（Nd:YAG）激光束比二氧化碳（CO2）激光能更深地穿透组织，随后具有更强的瘢痕形成能力。在本研究中，我们调查了Nd:YAG激光辅助悬雍垂成形术（LAUP）手术的疗效。
研究对象为2004年至2005年期间在格但斯克医科大学耳鼻喉科接受治疗的51例OSAS患者。所有患者均接受整夜多导睡眠图（PSG）检查，并使用爱泼华嗜睡量表（ESS）评分来评估日间嗜睡情况。进行了手术治疗，所有患者均接受了LAUP，必要时还进行了舌根部激光汽化、扁桃体切除术和鼻腔手术。术后6个月进行包括ESS和整夜PSG的耳鼻喉科检查。
29例患者治疗成功，他们的呼吸暂停低通气指数（AHI）<10且ESS<12。另外22例患者的PSG参数和ESS评分有所改善，但仍超出正常范围。术前AHI为I度的患者中14/16例治疗成功，AHI为II度的患者中10/19例，AHI为III度的患者中4/16例。成功组中为扩大气道通路而进行鼻腔手术的频率更高（25/32），高于部分改善组（9/19）。术前有鼻塞的患者PSG参数更好。与体重指数（BMI）<30的患者相比，BMI≥30的患者很少成功（10/22）（BMI<30的患者中24/29例成功）。BMI<30的患者术前PSG参数更好。
对于非肥胖患者轻中度OSAS的手术治疗，Nd:YAG激光辅助悬雍垂成形术联合额外的扁桃体切除术、舌根部手术和鼻腔手术是一种成功的方法。
