改良舌根牵拉术联合UPPP治疗重度OSA

The efficacy of the improved tongue base suspension surgery combined with UPPP in the treatment of severe OSA

目的:探讨改良舌根牵拉术联合UPPP治疗FriedmanⅡ、Ⅲ型重度OSA患者的可行性。方法:选择经PSG检查确诊的FriedmanⅡ型及Ⅲ型重度OSA患者进行改良舌根牵拉手术。改良舌根牵拉术在患者舌根植入钛板并用牵拉线固定于下颌骨颏部。UPPP手术参考改良UPPP进行。术后定期随访,复查PSG,观察记录各种主客观指标的康复情况和不良反应。结果:102例不耐受或不愿意使用持续气道正压通气治疗的重度OSA患者接受上述手术方法治疗。全部患者手术过程顺利,1个月后基本康复,无明显舌根疼痛、异物感等不适,进食和言语如常,伤口愈合良好,未出现严重感染和排斥反应。术后不良反应主要为牵拉线断裂(3例)。有67例患者完成了随访,术后3～6个月呼吸暂停低通气指数(AHI)、ESS嗜睡评分、鼾声指数较术前降低,最低血氧饱和度、血氧低于90%所占时间比较术前提高,均差异有统计学意义(P<0.01);术前AHI为60.5±22.4,术后3～6个月AHI为27.8±22.4,手术有效率为71.6%,成功率为58.2%;AHI平均下降54.0%,鼾声改善率为63.9%。结论:改良舌根牵拉术加UPPP治疗FriedmanⅡ型及Ⅲ型重度OSA具有较满意的疗效及可行性。

Objective: This study was designed to show the preliminary efficacy and safety of the improved tongue base suspension surgery in severe obstructive sleep apnea(OSA) patients classified as Friedman Ⅱand Friedman Ⅲ. Method: The severe OSA patients diagnosed by PSG as Friedman Ⅱ type and Ⅲ type underwent surgery treatment. The tongue base of the patient was implanted with titanium plate and fixed on the chin of mandible. The UPPP surgery was performed with reference to H-UPPP. After surgery, the patients were followed up, PSG was re-examined and the change of various subjective and objective indicators of rehabilitation and adverse reactions were observed and recorded. Result: One hundred and two patients with severe OSA who were not tolerant or unwilling to use CPAP treatment were treated by the above surgical method. All the patients underwent surgery successfully and generally recovered about 1 month after the surgery without obvious tongue base pain, foreign body sensation or other discomfort. Eating and speaking function were as usual, the wound was healed well, and no serious infection or rejection was observed. The main postoperative adverse reactionwas tension line fracture(3 cases). Sixty-seven patients completed follow-up. At 3 to 6 months after surgery, the AHI, ESS sleepiness score and snore index were lower than those before surgery, while LSaO2and CT 90% were higher than those before surgery(P<0.01). The AHI before surgery was 60.5± 22.4, and the average AHI after surgery was 27.8± 22.4. The effective rate of the surgery was 71.6% and the success rate was 58.2%. The AHI has dropped by an average of 54.0%, and snore improved by 63.9%. Conclusion: After preliminary clinical observation, the study suggests that the improved tongue base suspension with UPPP has satisfactory curative effect and feasibility for the treatment of severe OSA patients classified as Friedman Ⅱ type and Ⅲ type.