McGuirt W F, Johnson J T, Sanders M H
Department of Otolaryngology, University of Pittsburgh School of Medicine, USA.
Laryngoscope. 1995 Nov;105(11):1253-5. doi: 10.1288/00005537-199511000-00021.
Factors that determine a successful outcome following uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA) are not well defined. This study was undertaken to determine if prior tonsillectomy is predictive of a lower response rate to UPPP. A retrospective review of a cohort undergoing UPPP alone or in combination with nasal septoplasty for OSA was undertaken. Preoperative and postoperative polysomnograms were obtained to evaluate the severity of the OSA. The sample was a consecutive series of 79 patients with OSA. Clinical evaluation was performed by both an otolaryngologist and a pulmonologist. Surgical treatment in this group of 79 patients included 52 UPPP and 27 UPPP in patients with prior tonsillectomy. Concurrent septoplasty was undertaken in 17 patients. Criteria for outcome were based on comparison of preoperative and postoperative polysomnograms (i.e., apnea index, respiratory disturbance index change, and lowest saturation). A response to therapy was defined as a reduction in apnea index greater than 50%. A success was defined as apnea index less than 5, reduction of respiratory disturbance index greater than 50%, and nadir saturation greater than 82%. In 79 patients with OSA, 78% responded and 37% reflected therapeutic successes. Patients with history of prior tonsillectomy were less likely to have therapeutic improvement following UPPP. In 52 patients without previous tonsillectomy, 88% responded and 52% had a successful outcome. Of those with previous tonsillectomy, 59% responded and 7% had a successful outcome. The status of previous tonsillectomy is an important prognostic indicator in the success of UPPP for the treatment of OSA. We speculate that the presence of palatine tonsils allows the removal of an extra measure of oropharyngeal tissue, thereby improving the likelihood of success for UPPP.
悬雍垂腭咽成形术（UPPP）治疗阻塞性睡眠呼吸暂停（OSA）后决定成功结果的因素尚未明确界定。本研究旨在确定既往扁桃体切除术是否预示UPPP的反应率较低。对一组单独接受UPPP或联合鼻中隔成形术治疗OSA的患者进行了回顾性研究。获取术前和术后多导睡眠图以评估OSA的严重程度。样本为79例连续的OSA患者。由耳鼻喉科医生和肺科医生进行临床评估。这79例患者的手术治疗包括52例单纯UPPP和27例既往有扁桃体切除术的患者接受UPPP。17例患者同时进行了鼻中隔成形术。结果标准基于术前和术后多导睡眠图的比较（即呼吸暂停指数、呼吸紊乱指数变化和最低血氧饱和度）。治疗反应定义为呼吸暂停指数降低大于50%。成功定义为呼吸暂停指数小于5、呼吸紊乱指数降低大于50%且最低血氧饱和度大于82%。在79例OSA患者中，78%有反应，37%显示治疗成功。既往有扁桃体切除术病史的患者在UPPP后治疗改善的可能性较小。在52例无既往扁桃体切除术的患者中，88%有反应，52%有成功的结果。在既往有扁桃体切除术的患者中，59%有反应，7%有成功的结果。既往扁桃体切除术的状态是UPPP治疗OSA成功的重要预后指标。我们推测腭扁桃体的存在允许额外切除一部分口咽组织，从而提高UPPP成功的可能性。
