Sher A E
Albany Medical College, New York, USA.
Curr Opin Pulm Med. 1995 Nov;1(6):504-11. doi: 10.1097/00063198-199511000-00013.
Uvulopalatopharyngoplasty has limited efficacy in treating obstructive sleep apnea, with excellent results achieved in fewer than half of patients who undergo this procedure. Attempting to select patients who have only retropalatal collapse of the pharynx increases the likelihood of a successful outcome. Although this type of patient selection has been attempted with various techniques, the validity of these approaches is not documented. Objective studies of the airway of awake and asleep patients with obstructive sleep apnea using fiberoptic flexible pharnygoscopy and manometry points to the disparity between observations and complexity of adequate assessment of the mechanism and pattern of pharyngeal collapse. Various approaches to treating the patient with obstructive sleep apnea surgically include uvulopalatopharyngoplasty, genioglossal advancement and hyoid myotomy and suspension, and maxillomandibular advancement. Results of these procedures vary in different reports, possibly due to variation in patient populations or surgical technique. Optimal treatment requires careful consideration of many patient variables and involves the use of a protocol that includes several surgical procedures. Laser-assisted uvulopalatoplasty lacks documentation of efficacy for patients with obstructive sleep apnea. The efficacy of this procedure is likely to prove very limited. Until its proper place in the surgical armamentarium is known, caution is warranted.
悬雍垂腭咽成形术在治疗阻塞性睡眠呼吸暂停方面疗效有限，接受该手术的患者中不到一半能取得良好效果。试图挑选仅存在咽后柱塌陷的患者可增加手术成功的可能性。尽管已尝试通过各种技术进行此类患者选择，但这些方法的有效性尚无文献记载。使用纤维光学软性喉镜和测压法对清醒和睡眠状态下的阻塞性睡眠呼吸暂停患者气道进行的客观研究表明，观察结果与充分评估咽塌陷机制和模式的复杂性之间存在差异。手术治疗阻塞性睡眠呼吸暂停患者的各种方法包括悬雍垂腭咽成形术、颏舌肌前移及舌骨肌切开悬吊术和上颌下颌前移术。这些手术的结果在不同报告中有所不同，可能是由于患者群体或手术技术的差异。最佳治疗需要仔细考虑许多患者变量，并采用包括多种外科手术的方案。激光辅助悬雍垂腭成形术对阻塞性睡眠呼吸暂停患者的疗效缺乏文献记载。该手术的疗效可能非常有限。在其在外科手术器械库中的合适位置明确之前，应谨慎使用。
