Lin Ho-Sheng, Rowley James A, Folbe Adam J, Yoo George H, Badr M Safwan, Chen Wei
Department of Otolaryngology-Head & Neck Surgery, Wayne State University and Karmanos Cancer Institute, Detroit, Michigan, U.S.A; Department of Surgery, Wayne State University, Detroit, Michigan, U.S.A.
Laryngoscope. 2015 Apr;125(4):1013-20. doi: 10.1002/lary.24970. Epub 2014 Oct 24.
OBJECTIVES/HYPOTHESIS: We reviewed our experience with the use of transoral robotic surgery (TORS) for base of tongue (BOT) reduction either alone or as part of multilevel strategy in the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS) in order to identify clinical characteristics that may be associated with surgical response.
Case series.
Between June 2010 and May 2014, BOT reduction via TORS ± partial epiglottectomy ± uvulopalatopharyngoplasty were performed on 72 patients with OSAHS. Thirty-nine patients (15 females and 24 males) with complete preoperative and postoperative clinical information including polysomnograms were included in this study.
Mean apnea-hypopnea index (AHI) was 43.9 ± 32.3 preoperatively and 21.9 ± 23.5 postoperatively and reflected a statistically significant (P < 0.001) AHI reduction of 50.9% ± 38.1%. Statistical significant reduction in daytime somnolence, as measured by Epworth Sleepiness Scale (15.6 ± 5.4 preoperatively vs. 5.7 ± 4.3 postoperatively; P < 0.001), was also achieved. No statistical significant difference was found between preoperative and postoperative body mass index (BMI) (32.9 ± 7.0 vs. 32.4 ± 7.3; P = 0.270). Surgical response, as defined by > 50% reduction in AHI and final AHI < 15 with resolution of daytime somnolence, was achieved in 21 patients (53.8%). Clinical characteristics found to be significantly different between the responders and nonresponders were BMI, AHI, and lateral velopharyngeal collapse. Patients with BMI < 30, AHI < 60, or absence of lateral velopharyngeal collapse have excellent surgical response rate of 88.2%, 67.9%, or 66.7%, respectively.
We identified three clinical characteristics associated with increased surgical response rate. This finding may be useful for patient selection and counseling prior to surgery.
目的/假设：我们回顾了经口机器人手术（TORS）单独用于舌根（BOT）缩小或作为多级策略的一部分治疗阻塞性睡眠呼吸暂停/低通气综合征（OSAHS）的经验，以确定可能与手术反应相关的临床特征。
病例系列。
2010年6月至2014年5月期间，对72例OSAHS患者进行了经TORS±部分会厌切除术±悬雍垂腭咽成形术的BOT缩小手术。本研究纳入了39例患者（15例女性和24例男性），他们有完整的术前和术后临床信息，包括多导睡眠图。
术前平均呼吸暂停低通气指数（AHI）为43.9±32.3，术后为21.9±23.5，AHI降低了50.9%±38.1%，差异有统计学意义（P<0.001）。通过爱泼沃斯嗜睡量表测量，日间嗜睡程度也有统计学意义的降低（术前15.6±5.4，术后5.7±4.3；P<0.001）。术前和术后体重指数（BMI）无统计学显著差异（32.9±7.0 vs. 32.4±7.3；P = 0.270）。21例患者（53.8%）实现了手术反应，定义为AHI降低>50%且最终AHI<15并伴有日间嗜睡症状消失。反应者和无反应者之间发现有显著差异的临床特征为BMI、AHI和腭咽侧方塌陷。BMI<30、AHI<60或无腭咽侧方塌陷的患者手术反应优良率分别为88.2%、67.9%或66.7%。
我们确定了三个与手术反应率增加相关的临床特征。这一发现可能有助于术前患者的选择和咨询。
