Bosco Gabriela, Morato Marta, Pérez-Martín Nuria, Navarro Andrés, Racionero Miguel A, O'Connor-Reina Carlos, Baptista Peter, Plaza Guillermo
Department of Otolaryngology Head and Neck Surgery, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain.
Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain.
J Clin Med. 2021 Oct 20;10(21):4822. doi: 10.3390/jcm10214822.
We report the results of one-stage multilevel upper airway surgery for patients who could not tolerate continuous positive airway pressure (CPAP). Patients treated with multilevel surgery at a University Hospital in 2015-2019 were identified from a prospectively maintained database. The inclusion criteria were aged 18-70 years, body mass index (BMI) < 35 kg/m, apnea-hypopnea index (AHI) > 20, and lingual tonsil hypertrophy grade 3 or 4. Drug-induced sleep endoscopy was performed before surgery in all patients. Multilevel surgery was performed in one stage and included expansion sphincter pharyngoplasty (ESP), coblation tongue base reduction (CTBR), and partial epiglottectomy (PE) as required. The outcome measures were postoperative AHI, time percentage oxygen saturation < 90%, and Epworth Sleepiness Scale (ESS) score. A total of 24 patients were included: median age 49.1 years, average BMI 27.26 kg/m, and 90% men. Ten patients received ESP plus CTBR plus PE, eight received ESP plus CTBR, and six received ESP plus PE. The mean preoperative AHI was 33.01 at baseline and improved to 17.7 ± 13 after surgery ( < 0.05). The ESS score decreased from 11 ± 5.11 to 7.9 ± 4.94 ( < 0.05). The surgical success rate according to Sher's criteria was 82.3%. The median follow-up was 23.3 months (range 12-36). These findings suggest that multilevel surgery is a safe and successful treatment of OSAHS.
我们报告了针对无法耐受持续气道正压通气（CPAP）的患者进行一期多级上气道手术的结果。从一个前瞻性维护的数据库中识别出2015年至2019年在一家大学医院接受多级手术治疗的患者。纳入标准为年龄18 - 70岁、体重指数（BMI）< 35 kg/m²、呼吸暂停低通气指数（AHI）> 20以及舌扁桃体肥大3级或4级。所有患者在手术前均进行了药物诱导睡眠内镜检查。一期进行多级手术，根据需要包括扩张括约肌咽成形术（ESP）、低温等离子舌根减容术（CTBR）和部分会厌切除术（PE）。观察指标为术后AHI、氧饱和度< 90%的时间百分比以及爱泼华嗜睡量表（ESS）评分。共纳入24例患者：中位年龄49.1岁，平均BMI 27.26 kg/m²，男性占90%。10例患者接受了ESP加CTBR加PE，8例接受了ESP加CTBR，6例接受了ESP加PE。术前平均AHI基线值为33.01，术后改善至17.7±13（P<0.05）。ESS评分从11±5.11降至7.9±4.94（P<0.05）。根据谢尔标准，手术成功率为82.3%。中位随访时间为23.3个月（范围12 - 36个月）。这些发现表明多级手术是治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的一种安全且成功的方法。
