Woodson B T, Wooten M R
Department of Otolaryngology and Human Communication, Medical College of Wisconsin, Milwuakee.
Otolaryngol Head Neck Surg. 1994 Jul;111(1):38-43. doi: 10.1177/019459989411100109.
The most widely reported surgical procedure for obstructive sleep apnea syndrome is uvulopalatopharyngoplasty. The success rate for this procedure is variable, and the reason for failure is incompletely understood. Failure in some patients is postulated to result from tongue-base obstruction. To investigate this, we identified the level of collapse and obstruction in 11 cases of uvulopalatopharyngoplasty failure, using upper airway manometry and videoendoscopy, while patients slept. Airway manometry measured the initial level of complete obstruction. Videoendoscopy identified significant resting airway narrowing (> 75%) at the tongue base on obstructed compared with nonobstructed breaths. Results of manometry indicated that the palate was the primary level of obstruction in eight (73%) compared with the tongue base in three (27%). However, collapse on videoendoscopy at the tongue base was observed in an additional three patients. A total of six patients (54%) demonstrated significant tongue-base abnormalities. In six patients with uvulopalatopharyngoplasty as the only pharyngeal surgery, one (17%) has an obstruction at the tongue base, as measured with manometry. Three of the six also had collapses at the tongue base, as measured endoscopically. Tongue-based abnormalities were identified in four of six (67%). Two additional patients who had failed uvulopalatopharyngoplasty and transpalatal advancement pharyngoplasty had obstructions on manometry at the level of tongue base. Six of eight (75%) palatopharyngoplasty failures demonstrated tongue-base collapse. In the three patients with tongue-base surgery, all had obstructions on manometry at the palate and none had endoscopic tongue-base collapse. These results indicate that in most uvulopalatopharyngoplasty failures the initial level of obstruction occurs at the palate.(ABSTRACT TRUNCATED AT 250 WORDS)
治疗阻塞性睡眠呼吸暂停综合征最常报道的外科手术是悬雍垂腭咽成形术。该手术的成功率各不相同，失败原因尚未完全明确。一些患者手术失败被推测是舌根阻塞所致。为对此进行研究，我们利用上气道测压法和视频内镜检查，在11例悬雍垂腭咽成形术失败的患者睡眠时确定其气道塌陷和阻塞的水平。气道测压法测量完全阻塞的初始水平。视频内镜检查发现，与无阻塞呼吸相比，阻塞呼吸时舌根处气道静息显著变窄（>75%）。测压结果表明，8例（73%）患者阻塞的主要部位在腭部，而3例（27%）在舌根。然而，另外3例患者在视频内镜检查时观察到舌根处塌陷。共有6例患者（54%）表现出明显的舌根异常。在仅接受悬雍垂腭咽成形术这一咽部手术的6例患者中，1例（17%）经测压显示舌根处存在阻塞。其中3例经内镜检查也发现舌根处塌陷。6例中有4例（67%）发现舌根异常。另外2例悬雍垂腭咽成形术失败且接受经腭前移咽成形术的患者经测压显示舌根水平存在阻塞。8例腭咽成形术失败患者中有6例（75%）表现出舌根塌陷。在3例接受舌根手术的患者中，所有患者经测压均显示腭部存在阻塞，且经内镜检查均未发现舌根塌陷。这些结果表明，在大多数悬雍垂腭咽成形术失败病例中，初始阻塞部位在腭部。（摘要截选至250词）
