Z型腭咽成形术联合内镜下低温等离子刀开放舌根切除术治疗重度阻塞性睡眠呼吸暂停低通气综合征
Z-palatopharyngoplasty Combined with Endoscopic Coblator Open Tongue Base Resection for Severe Obstructive Sleep Apnea/Hypopnea Syndrome.
作者信息
Lin Hsin-Ching, Friedman Michael, Chang Hsueh-Wen, Yalamanchali Sreeya
机构信息
Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Rush University Medical Center, Chicago, Illinois, USA Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.
出版信息
Otolaryngol Head Neck Surg. 2014 Jun;150(6):1078-85. doi: 10.1177/0194599814524722. Epub 2014 Mar 4.
OBJECTIVES
To investigate the safety and outcomes of Z-palatopharyngoplasty (ZPPP) combined with endoscopic Coblator open tongue base resection (Eco-TBR) for the treatment of severe obstructive sleep apnea/hypopnea syndrome (OSAHS).
STUDY DESIGN
Review of a prospective database.
SETTING
Academic tertiary medical center.
METHODS
Thirty-nine patients with severe OSAHS who had multilevel obstruction, failed continuous positive airway pressure therapy, and then underwent ZPPP plus Eco-TBR were enrolled in this study. The subjective symptoms and objective polysomnography parameters were collected preoperatively and at a minimum of 12 weeks postoperatively. Statistical analysis was determined by the Wilcoxon signed rank test.
RESULTS
Thirty-five patients, consisting of 3 female and 32 male patients (mean age, 42 years), had completed data for final analysis. None of the patients had perioperative or postoperative serious complications. The classical success rate was 62.9% (22/35). Three months postoperatively, the Epworth Sleepiness Scale decreased from 11.0 ± 4.2 to 8.7 ± 4.3 (P = .0006). The mean apnea/hypopnea index decreased from 50.6 ± 16.6 to 26.5 ± 23.5 events/h, the lowest oxygen saturation (%) improved from 70.4 ± 9.9 to 80.1 ± 11.3, and the snoring visual analog scale (0-10) as assessed by bed partner decreased from 9.86 ± 0.69 to 3.27 ± 1.96 (P < .0001 for all variables).
CONCLUSION
This study shows the significant benefits of ZPPP plus Eco-TBR in patients with severe OSAHS.
目的
探讨Z型腭咽成形术（ZPPP）联合内镜下低温等离子舌根切除术（Eco-TBR）治疗重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的安全性及疗效。
研究设计
回顾前瞻性数据库。
研究地点
学术性三级医疗中心。
方法
本研究纳入39例重度OSAHS患者，这些患者存在多平面阻塞，持续气道正压通气治疗失败，随后接受了ZPPP联合Eco-TBR手术。术前及术后至少12周收集主观症状和客观多导睡眠图参数。采用Wilcoxon符号秩和检验进行统计分析。
结果
35例患者（3例女性，32例男性，平均年龄42岁）完成了最终分析所需数据。所有患者均未出现围手术期或术后严重并发症。经典成功率为62.9%（22/35）。术后3个月，爱泼沃斯嗜睡量表评分从11.0±4.2降至8.7±4.3（P = 0.0006）。平均呼吸暂停/低通气指数从50.6±16.6降至26.5±23.5次/小时，最低血氧饱和度（%）从70.4±9.9提高到80.1±11.3，配偶评估的鼾声视觉模拟量表（0-10）评分从9.86±0.69降至3.27±1.96（所有变量P < 0.0001）。
结论
本研究表明ZPPP联合Eco-TBR治疗重度OSAHS患者有显著益处。
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