射频消融治疗阻塞性睡眠呼吸暂停低通气综合征的疗效与适应证选择

Effect and indications of radiofrequency ablation for the treatment of obstructive sleep apnea-hypopnea syndrome

目的:探讨低温等离子射频消融术(RFA)在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)中应用的疗效及适应证。方法:对74例OSAHS患者(轻度16例,中度23例,重度35例)分别行不同狭窄部位的射频治疗,术后早期观察术区反应,评价射频治疗对局部疼痛、讲话、吞咽的影响;术后3个月检查治疗部位的体积,测量软腭和悬雍垂长度;术后6个月复查PSG、嗜睡量表及打鼾等级评分问卷调查,并与术前比较。主要依据PSG结果评价总有效率。结果:在74例患者中,治愈率为6.76%,显效率为27.03%,有效率为22.97%,总有效率为56.76%。术后AHI和最低SaO2均较术前改善(均P<0.01)。对于所有狭窄部位均得到射频治疗的患者,其总有效率为72.92%,优于尚有狭窄部位未处理的患者(P<0.01)。射频治疗后白天嗜睡程度和鼾声评级均较术前改善(P<0.01)。手术对局部疼痛、讲话及吞咽的影响很小。术后3个月大部分射频治疗过的部位,体积(或长度)均较术前明显缩小(或缩短)。结论:RFA对局部组织的消融效果确切,只要阻塞定位准确,相应治疗OS-AHS患者近期均有一定疗效。单纯鼻甲肥大所致鼾症或轻度OSAHS,射频治疗效果最为满意,软腭肥厚悬雍垂肥大、扁桃体肥大的治疗部分有效,但程度有限。射频治疗需要与其他治疗手段结合使用,或作为其他治疗的补充手段。

Objective：To explore the effect and indications of radiofrequency ablation for the treatment of obstructive sleep apnea-hypopnea syndrome. Method：Multilevel temperature-controlled radiofrequency therapy of soft palate, uvula, inferior turbinate, and tonsils were applied to 74 adults with obstructive sleep apnea-hypopnea syndrome （OSAHS）. There were 16 mild, 23 moderate, and 35 severe cases respectively in this study. Evaluation of mucosal injury and effect of radiofrequency therapy on pain, speech and swallowing were performed early after operation. The volume of targets and length of soft palate and uvula were measured three months after operation. Polysomnography, Epworth Sleepiness Scale and Snoring Scale Score questionnaires were reevaluated six months after operation and compared with the results of pre-operation. Treatment outcome measurements were mainly based on polysomnography. Result.. By our definition, 5 of 74 patients （6, 760/6） have been cured and 42 of 74 （56.76%） had improved totally. Mean Apnea- Hypopnea Index （AHI） decreased significantly and mean lowest oxygen saturation value increased significantly postoperatively （ P d0. 01）. The total effective rate of the patients, whose obstructive sites were all treated by radiofrequency, was remarkably higher than that of the ones, whose obstructive sites were only partly treated by radiofrequency（ P d0.01）. The total effective rate of the former was 72.92%. Patients showed a significant decrease in mean score on ESS and SSS postoperatively（ P 0.01）. No significant complications were observed in most patients. There were little influence on pain, speech and swallowing. The volume or length of targets decreased obviously three months after operation. Conclusion： Radiofrequency can reduce the volume of tissue. The short-term outcomes of radiofrequency were satisfying if obstructive sites had been all treated. This study demonstrates that the characters of radiofrequency are as follows; minimally invasive, safe, efficient, repeatable and multilevel applicable. Temperature-controlled radiofrequency therapy is a safe and effective procedure for hypertrophic infraturbinal when used separately , or as a part of a the combined approach, for complex syndromes.