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悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停-初步研究。

Suspension Palatoplasty for Obstructive Sleep Apnea- A Preliminary Study.

机构信息

Department of Otorhinolaryngology - Head and Neck Surgery, Sleep Center, Linkou-Chang Gung Memorial Hospital, Taoyuan City, 33305, Taiwan R.O.C..

Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan R.O.C..

出版信息

Sci Rep. 2018 Mar 9;8(1):4224. doi: 10.1038/s41598-018-22710-1.

Abstract

Suspension palatoplasty, a new surgical technique to treat obstructive sleep apnea (OSA), has been developed to correct the retropalatal obstruction in patients with small tonsils (grade I/II) and anterior-posterior palatal (A-P) obstruction. The objecteive of this preliminary study was to investigate the effectiveness and change in retropalatal airway dimensions after suspension palatoplasty. This retrospective case series study included 25 consecutive male adults with OSA. Unique technical features of suspension palatoplasty are exposure of pterygomandibular raphe and suspension of palatopharyngeus muscle to the raphe. Six months after suspension palatoplasty, apnea-hyponea index significantly reduced from 39.8 to 15.1 (effect size = 1.6). None experienced postoperative bleeding and velopharyngeal insufficiency 1 month following surgery. Subjective snoring severity (visual analogue scale) and daytime sleepiness (the Epworth Sleepiness Scale) significantly improved (8.7 vs 2.0 and 10.2 vs 4.9, respectively). A-P dimension of the retropalatal airspace widened significantly on perioperative endoscopy (23.0 units vs 184.6 unites) as well as posterior air space in cephalometry (7.6 mm vs 10.2 mm). Our preliminary findings show that suspension palatoplasty seems to be an effective OSA surgery in the specific patient population with minimal complications, however, further studies including a large number of patients are required to confirm the findings.

摘要

悬雍垂腭成形术是一种治疗阻塞性睡眠呼吸暂停(OSA)的新手术技术,旨在纠正小扁桃体(I/II 级)和前后腭(A-P)阻塞患者的后腭阻塞。本初步研究的目的是研究悬雍垂腭成形术后后腭气道尺寸的变化和有效性。这项回顾性病例系列研究纳入了 25 例连续的 OSA 男性成年患者。悬雍垂腭成形术的独特技术特征包括暴露翼下颌缝和将腭咽肌悬于缝上。悬雍垂腭成形术后 6 个月,呼吸暂停低通气指数从 39.8 显著降低至 15.1(效应量=1.6)。无一例患者在手术后 1 个月发生术后出血和腭咽闭合不全。主观打鼾严重程度(视觉模拟量表)和白天嗜睡(Epworth 嗜睡量表)显著改善(分别为 8.7 对 2.0 和 10.2 对 4.9)。围手术期内窥镜检查发现后腭气道的 A-P 尺寸显著变宽(23.0 单位对 184.6 单位),头影测量法中的后气道空间也显著变宽(7.6mm 对 10.2mm)。我们的初步研究结果表明,悬雍垂腭成形术在特定的患者群体中似乎是一种有效的 OSA 手术,并发症较少,但是,需要进一步的包括大量患者的研究来证实这一发现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c485/5844908/39d5937d371e/41598_2018_22710_Fig1_HTML.jpg

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