Li Hsueh-Yu, Lee Li-Ang, Kezirian Eric J
Department of Otolaryngology, Sleep Center, Linkou-Chang Gung Memorial Hospital, School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Sleep Medicine, Royal Infirmary Edinburgh, Edinburgh, UK.
Eur Arch Otorhinolaryngol. 2016 Jan;273(1):231-6. doi: 10.1007/s00405-014-3475-7. Epub 2015 Jan 13.
This study investigated the feasibility, safety and efficacy of Coblation endoscopic lingual lightening (CELL) surgery for obstructive sleep apnea (OSA). This study was a retrospective case series in a tertiary referral sleep center. Twenty-five adults with moderate to severe OSA and determined to have retropalatal and tongue base obstruction based on Friedman tongue position III and fiberoptic endoscopy underwent CELL in combination with modified uvulopalatopharyngoplasty, known as relocation pharyngoplasty. CELL involves transoral resection of tongue base muscle tissue and lingual tonsil using Coblation under endoscopic guidance. The mean operation time for CELL was 42.6 ± 13.7 min. Total blood loss for CELL plus relocation pharyngoplasty was <50 ml in all patients. Mean postoperative pain score (sum of total pain scores/sum of total hospitalization day, visual analog scale, 0-10) was 2.6 ± 0.6. Postoperative bleeding and taste disturbance extending beyond 3 months occurred in one patient (4 %) individually. No patients reported tongue weakness or speech dysfunction. Epworth sleepiness scale improved from 9.6 ± 4.9 to 7.5 ± 4.3 (p = 0.023). Apnea-hypopnea index decreased from 45.7 ± 21.7 to 12.8 ± 8.2 events/hour (p < 0.001) 6 months after surgery. The overall response rate was 80 %. CELL is feasible, safe and effective in treating tongue base obstruction in OSA patients who underwent simultaneous relocation pharyngoplasty.
本研究探讨了低温等离子内镜下舌部减容（CELL）手术治疗阻塞性睡眠呼吸暂停（OSA）的可行性、安全性和有效性。本研究是在一家三级转诊睡眠中心进行的回顾性病例系列研究。25例中重度OSA成人患者，根据Friedman舌位Ⅲ级和纤维喉镜检查确定存在腭后和舌根阻塞，接受了CELL联合改良悬雍垂腭咽成形术（即移位咽成形术）。CELL包括在内镜引导下使用低温等离子经口切除舌根肌肉组织和舌扁桃体。CELL的平均手术时间为42.6±13.7分钟。所有患者CELL联合移位咽成形术的总失血量均<50 ml。术后平均疼痛评分（总疼痛评分总和/总住院天数总和，视觉模拟量表，0-10）为2.6±0.6。1例患者（4%）分别出现术后出血和持续超过3个月的味觉障碍。无患者报告舌肌无力或言语功能障碍。Epworth嗜睡量表评分从9.6±4.9改善至7.5±4.3（p=0.023）。术后6个月，呼吸暂停低通气指数从45.7±21.7降至12.8±8.2次/小时（p<0.001）。总体有效率为80%。对于同时接受移位咽成形术的OSA患者，CELL治疗舌根阻塞是可行、安全且有效的。
