Propst Evan J, Amin Reshma, Talwar Natasha, Zaman Michele, Zweerink Allison, Blaser Susan, Zaarour Christian, Luginbuehl Igor, Karsli Cengiz, Aziza Albert, Forrest Christopher, Drake James, Narang Indra
Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Hospital for Sick Children, Toronto, Canada.
Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, Canada.
Laryngoscope. 2017 Mar;127(3):757-763. doi: 10.1002/lary.26104. Epub 2016 Jun 27.
OBJECTIVES/HYPOTHESIS: To examine outcomes following midline posterior glossectomy (MPG) plus lingual tonsillectomy (LT) for the treatment of significant obstructive sleep apnea (OSA) in children with Down syndrome (DS).
Patients with DS who had persistent OSA following tonsillectomy and adenoidectomy (TA) and were relatively intolerant of positive airway pressure (PAP) therapy were evaluated by physical examination and sleep/CINE magnetic resonance imaging to determine the etiology of upper airway obstruction. Patients with relative macroglossia underwent MPG plus LT if required. Successful surgical outcome was defined as the resolution of OSA or the ability to tolerate PAP.
Thirteen children (8 male, 5 female), mean (standard deviation) age 14.2 (4.0) years underwent MPG plus LT. Fifty-four percent of patients were obese (Body mass index [BMI] > 95th centile) and 8% were overweight (BMI 85th-95th centile) preoperatively. All patients underwent pre- and postoperative polysomnography. Postoperatively, the obstructive apnea-hypopnea index fell significantly from 47.0/hour to 5.6/hour (P <.05) in normal weight individuals who did not become obese, but not in obese patients or those who became obese postoperatively. Successful surgical outcome was seen in all (N = 6) children who were normal weight or overweight preoperatively compared with none who were obese preoperatively (N = 7).
Midline posterior glossectomy and LT are beneficial in normal weight and overweight children with DS who have persistent OSA following TA and are intolerant of PAP therapy. Obesity pre- or postoperatively portends a worse prognosis following MPG, suggesting that aggressive weight loss initiatives should be considered as an adjunct to surgery in this population.
目的/假设：探讨中线后舌切除术（MPG）联合舌扁桃体切除术（LT）治疗唐氏综合征（DS）患儿重度阻塞性睡眠呼吸暂停（OSA）的疗效。
对扁桃体切除术和腺样体切除术（TA）后仍存在持续性OSA且相对不耐受气道正压通气（PAP）治疗的DS患儿进行体格检查及睡眠/电影磁共振成像评估，以确定上气道阻塞的病因。必要时，对相对巨舌症患儿行MPG联合LT。手术成功的定义为OSA得到解决或能够耐受PAP。
13例儿童（8例男性，5例女性）接受了MPG联合LT，平均（标准差）年龄为14.2（4.0）岁。术前54%的患者肥胖（体重指数[BMI]>第95百分位数），8%超重（BMI为第85 - 95百分位数）。所有患者均进行了术前和术后多导睡眠图检查。术后，体重正常且未变肥胖的个体阻塞性呼吸暂停低通气指数从47.0次/小时显著降至5.6次/小时（P<.05），但肥胖患者或术后变肥胖的患者未出现这种情况。术前体重正常或超重的所有患儿（N = 6）手术成功，而术前肥胖的患儿无一例成功（N = 7）。
中线后舌切除术和LT对TA后仍存在持续性OSA且不耐受PAP治疗的体重正常和超重的DS患儿有益。术前或术后肥胖预示MPG术后预后较差，提示应考虑积极的减重措施作为该人群手术的辅助手段。
4。《喉镜》，127:757 - 763，2017年。
