Department of Otolaryngology-Head and Neck Surgery, Akdeniz University School of Medicine, Antalya, Turkey.
Laryngoscope. 2020 Sep;130(9):2285-2291. doi: 10.1002/lary.28443. Epub 2019 Nov 29.
OBJECTIVES/HYPOTHESIS: Our primary objective was to evaluate the feasibility, morbidity, and efficacy of transoral robotic surgery (TORS) tongue-base resection (TBR) combined with tongue-base suspension (TBS) for obstructive sleep apnea (OSA) with tongue-base collapse. Our secondary objective included evaluation of factors influencing treatment success.
Single-arm, prospective, observational cohort study.
Patients were eligible if they had moderate-to-severe OSA (apnea hypopnea index [AHI] > 15) or positional OSA, had a tongue-base collapse and glossoptosis identified by drug-induced sleep endoscopy (DISE), and failed continuous positive airway pressure. All patients underwent TORS-TBR combined with TBS. Additionally, concomitant epiglottoplasty, uvulopalatopharyngoplasty, or expansion pharyngoplasty were performed based on DISE findings.
In total, 64 patients were enrolled in the trial. The mean age was 45.9 years, mean body mass index was 30.5 kg/m , and mean AHI was 41.7 events/hour. The mean robotic surgical time, total volume of tongue-base tissue removed, and the length of hospital stay were 21.4 minutes, 15.16 mL, and 6.5 days, respectively. Postoperatively, almost all polysomnographic metrics improved significantly (AHI = 41.72 vs. 18.82 events/hour, lowest oxygen saturation = 80.43% vs. 85.14%, Epworth Sleepiness Scale = 10.49 vs. 4.09). The procedure provided an overall success rate of 75%, with minor morbidity. All patients experienced varying degrees of temporary lingual edema postoperatively. Tracheotomy was not required for any patient. Although no independent predictor of treatment success was determined, patients with more severe disease tend to exhibit lower response to the treatment.
TORS-TBR combined with TBS is a feasible, safe, and efficient procedure for OSA with tongue-base collapse.
4 Laryngoscope, 130:2285-2291, 2020.
目的/假设：我们的主要目标是评估经口机器人手术（TORS）舌底切除术（TBR）联合舌底悬吊术（TBS）治疗以舌底塌陷为特征的阻塞性睡眠呼吸暂停（OSA）的可行性、发病率和疗效。我们的次要目标包括评估影响治疗成功的因素。
单臂、前瞻性、观察性队列研究。
如果患者患有中重度 OSA（呼吸暂停低通气指数 [AHI] > 15）或位置性 OSA，药物诱导睡眠内窥镜检查（DISE）显示舌底塌陷和软腭下垂，且持续气道正压通气失败，则符合入组标准。所有患者均接受 TORS-TBR 联合 TBS 治疗。此外，根据 DISE 检查结果，同时进行会厌成形术、悬雍垂腭咽成形术或扩展咽成形术。
共有 64 例患者入组该试验。患者平均年龄为 45.9 岁，平均体重指数为 30.5kg/m2，平均 AHI 为 41.7 次/小时。机器人手术的平均时间、舌底组织切除的总体积和住院时间分别为 21.4 分钟、15.16mL 和 6.5 天。术后，所有多导睡眠图指标均显著改善（AHI = 41.72 与 18.82 次/小时，最低血氧饱和度 = 80.43% 与 85.14%，Epworth 睡眠量表 = 10.49 与 4.09）。该手术的总成功率为 75%，且并发症轻微。所有患者术后均出现不同程度的暂时性舌肿胀。没有患者需要气管切开术。尽管没有确定治疗成功的独立预测因素，但病情更严重的患者治疗反应较低。
TORS-TBR 联合 TBS 是治疗以舌底塌陷为特征的 OSA 的一种可行、安全且有效的方法。
4 级喉镜，130：2285-2291，2020 年。
