Wee Jee Hye, Tan Kenglu, Lee Woo-Hyun, Rhee Chae-Seo, Kim Jeong-Whun
Department of Otorhinolaryngology-Head and Neck Surgery, National Medical Center, 245 Eulgiro, Jung-gu, Seoul, South Korea.
Eur Arch Otorhinolaryngol. 2015 Sep;272(9):2327-33. doi: 10.1007/s00405-014-3330-x. Epub 2014 Oct 17.
Retroglossal obstruction is one of the etiologies causing obstructive sleep apnea (OSA) and can be addressed by removing some tissues of the tongue base. However, because of its deep-seated location, its surgical removal is still challenging. Although coblation technique has been introduced, its efficacy and morbidity need further evaluation, particularly in Asians. This study aimed to assess its safety and effectiveness and to identify outcome prognosticators. Forty-seven OSA patients who underwent coblation lingual tonsil removal were included. Retroglossal obstruction was confirmed by drug-induced sleep videofluoroscopy. Attended full-night polysomnography was performed twice; before and 6 months after surgery in 27 patients. The tongue base was fully exposed with three deep-seated traction sutures, visualized with a 30° or 70° endoscope, and ablated using a coblator. Surgical success was defined with postoperative apnea hypopnea index (AHI) <20 and reduction >50 %. Postoperative morbidities were evaluated. Demographic and polysomnographic parameters between success and failure groups were compared. None of the patients had immediate postoperative hemorrhage. Postoperatively, one patient had delayed hemorrhage and one patient severe respiratory difficulty. Taste loss, tongue dysmotility, dental injury or severe oropharyngeal stricture were absent. A mean AHI decreased from 37.7 ± 18.6 to 18.7 ± 14.8/h (P < 0.001). The success rate was 55.6 %. Their mean minimal oxygen saturation was significantly lower (P = 0.004) in the failure group. Coblation lingual tonsil removal technique showed minimal morbidity and favorable outcome in Koreans. The surgical outcome might be associated with the severity of single respiratory events.
舌后阻塞是导致阻塞性睡眠呼吸暂停（OSA）的病因之一，可通过切除部分舌根组织来解决。然而，由于其位置较深，手术切除仍具有挑战性。尽管已引入了低温等离子消融技术，但其疗效和并发症仍需进一步评估，尤其是在亚洲人群中。本研究旨在评估其安全性和有效性，并确定预后预测因素。纳入了47例接受低温等离子消融舌扁桃体切除术的OSA患者。通过药物诱导睡眠视频荧光造影术确认舌后阻塞。对27例患者在手术前和术后6个月进行了两次整夜多导睡眠监测。通过三根深部牵引缝线充分暴露舌根，使用30°或70°内窥镜进行观察，并用低温等离子消融器进行消融。手术成功的定义为术后呼吸暂停低通气指数（AHI）<20且降低>50%。评估术后并发症。比较成功组和失败组之间的人口统计学和多导睡眠图参数。所有患者术后均未立即出血。术后，1例患者出现延迟出血，1例患者出现严重呼吸困难。未出现味觉丧失、舌运动障碍、牙齿损伤或严重的口咽狭窄。平均AHI从37.7±18.6降至18.7±14.8次/小时（P<0.001）。成功率为55.6%。失败组的平均最低血氧饱和度显著较低（P = 0.004）。低温等离子消融舌扁桃体切除术在韩国人中显示出最小的并发症和良好的预后。手术结果可能与单次呼吸事件的严重程度有关。
