Lombo Catarina, Costa Ricardo, Martins Margarida, Matos Carlos, Fonseca Rui
Department of Otorhinolaryngology, Hospital Senhora da Oliveira de Guimarães, Portugal.
Department of Otorhinolaryngology, Hospital Senhora da Oliveira de Guimarães, Portugal.
Acta Otorrinolaringol Esp (Engl Ed). 2022 Nov-Dec;73(6):362-369. doi: 10.1016/j.otoeng.2021.11.004.
Obstructive sleep apnea is the most frequent sleep disorder worldwide, with rising incidence. Pharyngoplasty is an alternative treatment in patients not suitable to continuous positive airway pressure devices (CPAP). The aim of this study is to compare different surgical techniques of pharyngoplasty for treatment of obstructive sleep apnea and evaluate its influence in surgical success.
Retrospective study of 92 patients that underwent pharyngoplasty for treatment of obstructive sleep apnea from 2001 to 2020. Included patients performed classic uvulopalatopharyngoplasty (UPPP), radiofrequency assisted uvulopalatopharyngoplasty (RF-UPPP) or barbed reposition pharyngoplasty (BRP). Surgical success was defined and outcomes and complications assessed for each procedure.
Most patients were male, with a mean age of 49.36±9.6 years and a mean apnea hypopnea index (AHI) of 29.14±2.94events/h. Thirty-six patients performed classic UPPP, thirty-one underwent RF-UPPP and the remaining twenty-five performed BRP. BRP achieved the highest success rate (66%) in comparison with UPPP (57%) and RF-UPPP (54%) (p=0.032). Mean relative AHI reduction after surgery was not statistically different between three procedures (p=0.098), although there was a tendency for greater reduction with BRP. Most symptoms improved after surgery and snoring was the most recurrent symptom. BRP had less foreign body sensation after surgery, however, it was the procedure with highest rate of post-operative tonsillar bleeding.
In our department, the introduction of recent techniques of velopharyngeal surgery, focused in functional and lateral muscular collapse, has translated into an increase in success rate after surgery. The relative ease of the procedure and reduction of long term complications make BRP an attractive alternative option for CPAP in OSA, in carefully selected patients.
阻塞性睡眠呼吸暂停是全球最常见的睡眠障碍，发病率呈上升趋势。咽成形术是不适用于持续气道正压通气设备（CPAP）患者的一种替代治疗方法。本研究的目的是比较不同的咽成形术手术技术治疗阻塞性睡眠呼吸暂停的效果，并评估其对手术成功率的影响。
对2001年至2020年接受咽成形术治疗阻塞性睡眠呼吸暂停的92例患者进行回顾性研究。纳入的患者接受了经典悬雍垂腭咽成形术（UPPP）、射频辅助悬雍垂腭咽成形术（RF-UPPP）或倒刺复位咽成形术（BRP）。定义手术成功率，并评估每种手术的结果和并发症。
大多数患者为男性，平均年龄49.36±9.6岁，平均呼吸暂停低通气指数（AHI）为29.14±2.94次/小时。36例患者接受经典UPPP，31例接受RF-UPPP，其余25例接受BRP。与UPPP（57%）和RF-UPPP（54%）相比，BRP的成功率最高（66%）（p=0.032）。三种手术术后平均相对AHI降低无统计学差异（p=0.098），尽管BRP有更大降低的趋势。大多数症状术后改善，打鼾是最常见的症状。BRP术后异物感较轻，然而，它是术后扁桃体出血率最高的手术。
在我们科室，腭咽手术新技术的引入，聚焦于功能和侧方肌肉塌陷，已转化为术后成功率的提高。该手术相对简便且长期并发症减少，使BRP成为精心挑选的阻塞性睡眠呼吸暂停患者CPAP治疗的有吸引力的替代选择。
