Zhang Junbo, Li Yanru, Cao Xin, Xian Junfang, Tan Junlong, Dong Jiajia, Ye Jingying
Department of Otolaryngology, Head and Neck Surgery, Beijing, China.
Laryngoscope. 2014 Jul;124(7):1718-23. doi: 10.1002/lary.24510. Epub 2013 Dec 18.
OBJECTIVES/HYPOTHESIS: To explore whether the variables resulting from anatomical and physiological examinations can be combined to predict the outcomes of velopharyngeal surgery for obstructive sleep apnea (OSA).
Prospective design with a retrospective review.
A total of 119 patients with OSA received velopharyngeal surgery, including revised uvulopalatopharyngoplasty with uvula preservation and transpalatal advancement pharyngoplasty. The preoperative examinations of these patients, including polysomnography (PSG), physical examination, and three-dimensional computer tomography (3-D CT), were obtained for analysis.
The overall success rate was 62.2%. Three factors were found to be predictive in treatment outcomes (P<0.05). These were tonsil size, the percentage of time with oxygen saturation below 90% (CT90), and the vertical distance between the lower edge of the mandible and the lower edge of the hyoid (MH). After changing CT90 and MH into level variables, another regression analysis was performed and the result suggested that all three level variables could be included. A scoring system was then created based on these three variables and their odds ratio values. The total scores of all patients were calculated by the following equation: Total score=2.7 tonsil size (score)+2.2 CT90 (score)+1.6 MH (score). The differences in success rates among patients with total scores of <14, 14 to 17, 17 to 22, and ≥22 were all significant (P<0.05).
The anatomy of the pharynx and the physiology of OSA are both important in deciding outcomes of velopharyngeal surgery. Variables that could represent these two aspects can be combined to better guide patient selections.
目的/假设：探讨解剖学和生理学检查得出的变量能否结合起来预测阻塞性睡眠呼吸暂停（OSA）腭咽手术的结果。
前瞻性设计并进行回顾性分析。
共有119例OSA患者接受了腭咽手术，包括保留悬雍垂的改良悬雍垂腭咽成形术和经腭前移咽成形术。获取这些患者的术前检查结果，包括多导睡眠图（PSG）、体格检查和三维计算机断层扫描（3-D CT），进行分析。
总体成功率为62.2%。发现有三个因素可预测治疗结果（P<0.05）。这些因素是扁桃体大小、血氧饱和度低于90%的时间百分比（CT90）以及下颌骨下缘与舌骨下缘之间的垂直距离（MH）。将CT90和MH转换为等级变量后，进行了另一项回归分析，结果表明所有三个等级变量均可纳入。然后根据这三个变量及其比值比创建了一个评分系统。所有患者的总分通过以下公式计算：总分=2.7×扁桃体大小（评分）+2.2×CT90（评分）+1.6×MH（评分）。总分<14、14至17、17至22和≥22的患者成功率差异均有统计学意义（P<0.05）。
咽部解剖结构和OSA生理学在决定腭咽手术结果方面均很重要。可将代表这两个方面的变量结合起来，以更好地指导患者选择。
4级。
