Tschopp Samuel, Meinert Flora, Mantokoudis Georgios, Caversaccio Marco, Borner Urs
Department of Otorhinolaryngology, Head and Neck Surgery Inselspital, University Hospital and University of Bern Bern Switzerland.
OTO Open. 2025 Jun 19;9(2):e70144. doi: 10.1002/oto2.70144. eCollection 2025 Apr-Jun.
The effectiveness of various palatopharyngeal surgeries is currently poorly understood. This study compares various palatopharyngeal surgery techniques without tonsillectomy for reducing the apnea-hypopnea index (AHI).
Embase, MEDLINE, Web of Science, ClinicalTrials, CINAHL, the Cochrane Library, and International Clinical Trials Registry Platform.
We included studies of palatopharyngeal surgery in adults reporting AHI outcomes, excluding those with tonsillectomy or combined surgeries. A random-effects model was used to pool effect sizes. Surgical techniques were categorized into cold steel, muscle relocation, suture, radiofrequency, laser, powered instruments, and implants. The primary outcome was the reduction in AHI. Secondary outcomes were the AHI responder rate, AHI reduction over the follow-up duration, and the outcomes by publication year.
From 3793 screened records, 45 studies with 1501 patients were included. Overall, palatopharyngeal surgery reduced AHI by 5.2/h (95% CI, 2.7-7.7; < .0001). Powered instruments showed the greatest AHI reduction (26.3/h; 95% CI, 18.9-33.7), followed by muscle relocation (20.2/h; 95% CI, 3.7-36.7) and suture techniques (15.3/h; 95% CI, 9.6-21.0). Palatal implants (2.6/h; 95% CI, 0.4-4.7) and laser techniques (4.5/h; 95% CI, 1.3-7.8) showed modest effects, whereas radiofrequency (0.4/h; 95% CI, -2.0 to 2.8) and cold steel (6.6/h; 95% CI, -0.2 to 13.5) had no significant impact. The overall responder rate was 51% (95% CI, 41-60), with powered instruments, relocation, and suture techniques demonstrating the highest rates.
Palatopharyngeal surgery techniques significantly differ in reducing AHI. Powered instruments, muscle relocation, and suture techniques are most effective.
PROSPERO identifier: CRD42024559063.
目前对各种腭咽手术的有效性了解不足。本研究比较了不进行扁桃体切除术的各种腭咽手术技术对降低呼吸暂停低通气指数（AHI）的效果。
Embase、MEDLINE、科学网、临床试验、护理学与健康领域数据库（CINAHL）、考克兰图书馆和国际临床试验注册平台。
我们纳入了报告AHI结果的成人腭咽手术研究，排除了进行扁桃体切除术或联合手术的研究。采用随机效应模型汇总效应量。手术技术分为冷刀、肌肉移位、缝合、射频、激光、动力器械和植入物。主要结局是AHI的降低。次要结局是AHI反应率、随访期间AHI的降低以及按发表年份划分的结局。
在3793条筛选记录中，纳入了45项研究，共1501例患者。总体而言，腭咽手术使AHI降低了5.2次/小时（95%置信区间，2.7 - 7.7；P <.0001）。动力器械使AHI降低幅度最大（26.3次/小时；95%置信区间，18.9 - 33.7），其次是肌肉移位（20.2次/小时；95%置信区间，3.7 - 36.7）和缝合技术（15.3次/小时；95%置信区间，9.6 - 21.0）。腭部植入物（2.6次/小时；95%置信区间，0.4 - 4.7）和激光技术（4.5次/小时；95%置信区间，1.3 - 7.8）效果一般，而射频（0.4次/小时；95%置信区间，-2.0至2.8）和冷刀（6.6次/小时；95%置信区间，-0.2至13.5）无显著影响。总体反应率为51%（95%置信区间，41 - 60），动力器械、移位和缝合技术的反应率最高。
腭咽手术技术在降低AHI方面存在显著差异。动力器械、肌肉移位和缝合技术最有效。
PROSPERO标识符：CRD42024559063。
