Yu W W, Zhu H M, Xu H H, Zou J Y, Li X Y, Liu Y P, Meng L L, Liu S R, Guan J, Yi H L, Li J P, Dong P, Yin S K
Department of Otorhinolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China.
Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Renji Hospital, Shanghai 200001, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Dec 7;56(12):1248-1255. doi: 10.3760/cma.j.cn115330-20210429-00237.
To compare the therapeutic efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS). This is a multicenter randomized controlled trial. From March 2017 to July 2019, moderate to severe OSAHS patients from three clinical center in Shanghai who were intolerant to continuous positive airway pressure (CPAP) and with velopharyngeal and glossopharyngeal plane obstruction were enrolled in this study. According to the surgical type, they were 1∶1 randomized to HUPPP plus radiofrequency ablation of tongue base group (Ablation group) or HUPPP plus traction of tongue base group (Traction group). All patients completed over-night standard Polysomnography (PSG), upper-airway assessment (Friedman classification, Müller test, CT and cephalometric examination), preoperative routine examination, Epworth Sleepiness Scale (ESS) and Quebec sleep questionnaire (QSQ). Six to 12 months after operation, all the above-mentioned examinations were repeatedly performed. Changes of aforementioned variables before and after operation were assessed. A total of 43 patients with moderate to severe OSAHS were enrolled in this study. One patient lost to follow-up, the remaining 21 were allocated to Ablation group and 21 were allocated to Traction group. The total therapeutic efficacy of all patients was 69.05% (61.90% in Ablation group and 76.19% in Traction group), but there was no statistical significance between the two groups (= 0.317). The value of sleep scale score (ESS and QSQ), objective sleep variables (apnea-hypopnea index, oxygen saturation, percentage of time with blood oxygen less than 90% in total sleep time, oxygen desaturation index and micro-arousals) and upper airway cross-sectional area (palatopharyngeal and retrolingual area) of the two groups were improved (<0.05), but the differences between the two groups were not statistically significant (>0.05). For moderate to severe OSAHS who had glossopharyngeal plane obstruction, both HUPPP plus radiofrequency ablation of tongue base or HUPPP plus traction of tongue base are effective treatment for OSAHS, and the curative effect is similar. The choice of surgical type could be selected according to patient's or surgical conditions.
比较悬雍垂腭咽成形术（HUPPP）联合舌根射频消融术与HUPPP联合舌根牵引术治疗中重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的疗效。这是一项多中心随机对照试验。2017年3月至2019年7月，纳入来自上海三个临床中心的中重度OSAHS患者，这些患者不耐受持续气道正压通气（CPAP）且存在腭咽和舌咽平面阻塞。根据手术类型，将他们按1∶1随机分为HUPPP联合舌根射频消融术组（消融组）或HUPPP联合舌根牵引术组（牵引组）。所有患者均完成整夜标准多导睡眠图（PSG）、上气道评估（弗里德曼分类、米勒试验、CT和头影测量检查）、术前常规检查、爱泼华嗜睡量表（ESS）和魁北克睡眠问卷（QSQ）。术后6至12个月，重复进行上述所有检查。评估上述变量术前和术后的变化。本研究共纳入43例中重度OSAHS患者。1例失访，其余21例分配至消融组，21例分配至牵引组。所有患者的总治疗有效率为69.05%（消融组为61.90%，牵引组为76.19%），但两组之间无统计学意义（=0.317）。两组的睡眠量表评分（ESS和QSQ）、客观睡眠变量（呼吸暂停低通气指数、血氧饱和度、总睡眠时间中血氧低于90%的时间百分比、氧饱和度下降指数和微觉醒）以及上气道横截面积（腭咽和舌后区域）均得到改善（<0.05），但两组之间的差异无统计学意义（>0.05）。对于存在舌咽平面阻塞的中重度OSAHS患者，HUPPP联合舌根射频消融术或HUPPP联合舌根牵引术均是治疗OSAHS的有效方法，且疗效相似。可根据患者情况或手术条件选择手术类型。
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