悬雍垂腭咽成形术联合（或不联合）改良甲状舌骨悬吊术治疗阻塞性睡眠呼吸暂停：一项随机临床试验。
Uvulopalatopharyngoplasty with and without modified thyrohyoid suspension for obstructive sleep apnea treatment: a randomized clinical trial.
机构信息
Department of Otorhinolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran.
Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
Eur Arch Otorhinolaryngol. 2023 Oct;280(10):4677-4685. doi: 10.1007/s00405-023-08068-9. Epub 2023 Jun 22.
PURPOSE
This study aims to compare the efficacy of Uvulopalatopharyngoplasty + Tongue Base Radiofrequency (TB-RF) and Uvulopalatopharyngoplasty + modified thyrohyoid suspension techniques + TB-RF which aimed to suspend base of tongue muscles anteriorly toward thyroid cartilage.
METHODS
This randomized controlled trial study was conducted on 48 cases of confirmed OSA between Jan, 2019 and Aug, 2022. We divided patients into two groups. One group underwent Uvulopalatopharyngoplasty + modified thyrohyoid suspension + TB-RF technique, and another one underwent Uvulopalatopharyngoplasty + TB-RF. Then, Apnea-Hypopnea Index (AHI), mean and lowest O saturation, Drug-Induced Sleep Endoscopy (DISE), Epworth Sleepiness Scale (ESS), Digit Symbol Substitution Test (DSST), Stanford Subjective Snoring Scale (SSSS), and T90 indexes were evaluated before and after each surgery.
RESULTS
The mean ± SD age was 39.4 ± 11.17 years. Of the 48 patients, 79.1% (n = 33) were male and 20.9% (n = 15) were female. AHI and SSSS in the Uvulopalatopharyngoplasty + modified thyrohyoid suspension group were significantly better than Uvulopalatopharyngoplasty group (P-value; 0.010). Though, there was no significant difference in terms of mean saturation, lowest desaturation, ESS, DSST, and T90 scores. The success rate in the Uvulopalatopharyngoplasty + modified thyrohyoid suspension and Uvulopalatopharyngoplasty groups, according to the Sher criteria: a minimum of 50% reduction with a final AHI less than 20, were 75% (18/24) and 41.7% (10/24), respectively. It was significantly higher in the Uvulopalatopharyngoplasty + modified thyrohyoid suspension group (P-value: 0.021).
CONCLUSION
The addition of modified thyrohyoid suspension technique to Uvulopalatopharyngoplasty have better surgical outcomes and more success rate than Uvulopalatopharyngoplasty in OSA patients.
TRIAL REGISTRATION
IRCT: IRCT20190602043791N2. https://en.irct.ir/trial/53365 .
目的
本研究旨在比较悬雍垂腭咽成形术 + 舌基射频（TB-RF）与悬雍垂腭咽成形术 + 改良甲状舌骨悬吊术 + TB-RF 的疗效，后者旨在将舌根肌肉向前悬吊至甲状软骨。
方法
本随机对照试验研究于 2019 年 1 月至 2022 年 8 月期间对 48 例确诊的 OSA 患者进行。我们将患者分为两组，一组接受悬雍垂腭咽成形术 + 改良甲状舌骨悬吊 + TB-RF 治疗，另一组接受悬雍垂腭咽成形术 + TB-RF。然后，在每次手术后评估呼吸暂停低通气指数（AHI）、平均和最低血氧饱和度、药物诱导睡眠内窥镜检查（DISE）、Epworth 嗜睡量表（ESS）、数字符号替代测试（DSST）、斯坦福主观打鼾量表（SSSS）和 T90 指数。
结果
患者的平均年龄为 39.4 ± 11.17 岁。48 例患者中，79.1%（n = 33）为男性，20.9%（n = 15）为女性。悬雍垂腭咽成形术 + 改良甲状舌骨悬吊组的 AHI 和 SSSS 明显优于悬雍垂腭咽成形术组（P 值；0.010）。然而，平均血氧饱和度、最低血氧饱和度下降、ESS、DSST 和 T90 评分无显著差异。根据 Sher 标准，悬雍垂腭咽成形术 + 改良甲状舌骨悬吊和悬雍垂腭咽成形术组的成功率（即至少减少 50%，最终 AHI 小于 20）分别为 75%（18/24）和 41.7%（10/24），前者明显更高（P 值：0.021）。
结论
与悬雍垂腭咽成形术相比，在 OSA 患者中，将改良甲状舌骨悬吊技术添加到悬雍垂腭咽成形术中具有更好的手术效果和更高的成功率。
试验注册
IRCT：IRCT20190602043791N2。https://en.irct.ir/trial/53365 。
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