Department of Otorhinolaryngology, Head and Neck Surgery, Yildirim Beyazit University School of Medicine, Ankara, Turkey.
Department of Otorhinolaryngology, Head and Neck Surgery, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.
Clin Otolaryngol. 2019 Nov;44(6):989-996. doi: 10.1111/coa.13424. Epub 2019 Oct 2.
The objective of this study was to determine the effectiveness and morbidities of two different tongue base surgical approaches in patients with obstructive sleep apnoea (OSA).
We carried out a prospective analysis in order to understand in detail the relative impact on apnoeas of the two different tongue base procedures. Seventy cases in 85 patients with OSA were divided into two operating groups and randomized. Altogether, 37 transoral robotic surgeries (TORS) and 33 coblations were performed. The patency of retrolingual passage was investigated by Muller's manoeuvere, polysomnography. Apnoea-hypopnea index (AHI) was the primary outcome measure with the Epworth Sleepiness Score (ESS). The final follow-up visit was at 6 months.
The AHI index improved from 29.7 ± 9 to 10.7 ± 3.9 (P < .005) following TORS and from 27.2 ± 6.4 to 10.3 ± 4 in the coblation group. Selecting a threshold of a 50% reduction in AHI and AHI less than 20 events/h, the overall success rate was 75.6% in TORS compared with 78.7% in coblation (P = .785). Similar results were seen in AHI reduction rates (36%, 37.8%, respectively). ESS showed a significant improvement 6 months following surgery in both groups.
Transoral robotic surgery technique showed higher complication rates than coblation. TORS and coblation of the tongue base represent a promising treatment option with a similar AHI improvement. However, coblation promises lower complication rates unlike TORS.
本研究旨在确定两种不同舌基手术方法对阻塞性睡眠呼吸暂停（OSA）患者的有效性和发病率。
为了详细了解两种不同舌基手术对呼吸暂停的相对影响，我们进行了前瞻性分析。85 例 OSA 患者共 70 例分为两组进行随机分组。共行 37 例经口机器人手术（TORS）和 33 例等离子手术。通过 Muller 手法、多导睡眠图检查舌后间隙通畅性。呼吸暂停低通气指数（AHI）是主要观察指标，Epworth 嗜睡评分（ESS）为次要观察指标。最终随访时间为 6 个月。
TORS 后 AHI 指数从 29.7±9 降至 10.7±3.9（P<.005），等离子组从 27.2±6.4降至 10.3±4。选择 AHI 降低 50%和 AHI 低于 20 次/小时作为阈值，TORS 的总有效率为 75.6%，等离子组为 78.7%（P=.785）。AHI 降低率也相似（分别为 36%和 37.8%）。两组术后 6 个月 ESS 均显著改善。
经口机器人手术技术的并发症发生率高于等离子。TORS 和舌基等离子消融术均是一种有前途的治疗选择，可显著改善 AHI。但与 TORS 不同，等离子手术具有较低的并发症发生率。
