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倒刺腭咽联合手术与低温等离子刀辅助中线舌切除术治疗阻塞性睡眠呼吸暂停的手术效果

Surgical Outcomes Following Combined Barbed Palato-Pharyngeal Surgery and Coblator-Assisted Midline Glossectomy for Obstructive Sleep Apnea.

作者信息

Sebastian Susan K, Arora Gautamkumar, Kumar C Anand, Noah Amrita Grace

机构信息

Department ENT and Head & Neck surgery, St. Stephen's Hospital, Delhi, 110054 India.

出版信息

Indian J Otolaryngol Head Neck Surg. 2024 Dec;76(6):5826-5832. doi: 10.1007/s12070-024-05112-w. Epub 2024 Oct 5.

Abstract

Surgical treatment of OSA has emerged as an effective alternative in continuos positive airway pressure (CPAP)-non-compliant group of patients. The present study examines the outcomes following a combination of barbed palatopharyngoplasty (BPP) and endoscopic coblator-assisted midline partial glossectomy in patients with multilevel obstruction of palate, oropharyngeal walls, and tongue base. A retrospective study of 40 patients with predominant obstruction at the velum, oropharyngeal lateral walls, and base of tongue levels, who underwent Barbed Palato Pharyngoplasty and Endoscopic coblator-assisted tongue base resection. Preoperative and post-operative Epworth Sleepiness Score (ESS), and Visual Analog Score (VAS) for snoring. Apnoea-Hypopnoea Index (AHI) and lowest oxygen saturation(L-Sat) were assessed by polysomnography. Improvement in qualityof life parameters were also evaluated. According to the AHI score, 55% of patients had severe OSA, while 45% of patients had moderate OSA. Sleep parameters like AHI, lowest oxygen saturation, and VAS score for snoring significantly improved after surgery (<0.0001). The overall success rate was 62.5%, according to Sher criteria. Following surgery, quality of life improvement in patient centered parameters was also observed in this study. Multilevel surgery with barbed palatopharyngoplasty combined with coblator-assisted midlie glossectomy is an effective treatment modality in patients with moderate-tosevere OSAS. The efficacy of combined surgical treatment was evidenced by improvements in PSG results and patient-centered quality of life parameters.

摘要

对于持续气道正压通气(CPAP)治疗依从性差的患者,手术治疗阻塞性睡眠呼吸暂停(OSA)已成为一种有效的替代方法。本研究探讨了倒刺腭咽成形术(BPP)与内镜下等离子辅助中线部分舌切除术联合应用于腭部、口咽壁和舌根多平面阻塞患者的治疗效果。对40例主要在软腭、口咽侧壁和舌根水平存在阻塞的患者进行回顾性研究,这些患者接受了倒刺腭咽成形术和内镜下等离子辅助舌根切除术。术前和术后采用爱泼华嗜睡量表(ESS)以及打鼾视觉模拟评分(VAS)。通过多导睡眠图评估呼吸暂停低通气指数(AHI)和最低血氧饱和度(L-Sat)。还评估了生活质量参数的改善情况。根据AHI评分,55%的患者患有重度OSA,而45%的患者患有中度OSA。术后AHI、最低血氧饱和度和打鼾VAS评分等睡眠参数显著改善(<0.0001)。根据谢尔标准,总体成功率为62.5%。在本研究中,术后还观察到以患者为中心的参数方面生活质量有所改善。倒刺腭咽成形术联合等离子辅助中线舌切除术的多平面手术是治疗中重度阻塞性睡眠呼吸暂停低通气综合征(OSAS)患者的一种有效治疗方式。多导睡眠图结果和以患者为中心的生活质量参数的改善证明了联合手术治疗的疗效。

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