Department of Otolaryngology-Head and Neck Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Laryngoscope. 2012 Nov;122(11):2582-6. doi: 10.1002/lary.23556. Epub 2012 Sep 10.
OBJECTIVES/HYPOTHESIS: To determine the safety and efficacy of tongue Coblation via the ventral approach in the treatment of hypopharyngeal obstruction for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).
Prospective case-control study.
Tongue Coblation was performed under local anesthesia in one session in 40 inpatients diagnosed with OSAHS with predominant hypopharyngeal obstruction after failed uvulopalatopharyngoplasty. In the ventral approach (n = 20), only one puncture point was applied at the center of lingual frenulum, and 12 radiofrequency volumetric tissue reduction (RFVTR) lesions were implanted in the tongue. In the dorsal approach (n = 20), eight RFVTR lesions were distributed on the tongue. Using portable polysomnography (PSG) and the Epworth sleepiness questionnaire (ESQ), we followed 36 patients for 1 year after the operation. Good outcome was defined as apnea-hypopnea index <20 or reduction >50%.
In the ventral approach, total energy was accumulated to 23,000 J in 12 lesions, with postoperative pain 2-3 by visual analog scale (VAS). There was only one case of moderate venous bleeding and hematoma. The ESQ comparison indicated subjective improvements in patients, and PSG showed a curative effect in 11 of 19 (61.11%, eight of 19 success plus three of 19 responders), with a failure rate of eight of 19. By contrast, in the dorsal approach, total energy was 16,000 J, with postoperative pain 3-4 (VAS). Complications included mild to moderate tongue venous hematoma, severe infection of tongue, and temporary mild glossal deviation. A curative effect was seen in six of 17, with a failure rate of 11 of 17.
Tongue Coblation via the ventral approach is an effective and safe technique to treat hypopharyngeal obstruction in OSAHS surgery.
目的/假设：确定经腹侧入路行舌 Coblation 治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者咽后阻塞的安全性和有效性。
前瞻性病例对照研究。
40 例 OSAHS 伴主要咽后阻塞的住院患者在局部麻醉下一次性行舌 Coblation 治疗。在腹侧入路（n = 20）中，仅在舌系带中心应用一个穿刺点，在舌内植入 12 个射频容积组织减少（RFVTR）病灶。在背侧入路（n = 20）中，将 8 个 RFVTR 病灶分布在舌上。使用便携式多导睡眠图（PSG）和 Epworth 嗜睡量表（ESQ），我们在术后随访了 36 例患者 1 年。良好的结果定义为呼吸暂停低通气指数<20 或减少>50%。
在腹侧入路中，12 个病灶的总能量累积到 23000 J，术后疼痛为 2-3 分（视觉模拟评分法[VAS]）。仅有 1 例中度静脉出血和血肿。ESQ 比较表明患者主观改善，19 例中有 11 例（61.11%，8 例成功加 3 例有反应）PSG 显示疗效，19 例中有 8 例失败。相比之下，在背侧入路中，总能量为 16000 J，术后疼痛为 3-4 分（VAS）。并发症包括轻度至中度舌静脉血肿、严重舌感染和暂时性轻度舌偏斜。17 例中有 6 例有效，17 例中有 11 例失败。
经腹侧入路行舌 Coblation 是治疗 OSAHS 手术中咽后阻塞的一种有效且安全的技术。
