OSA舌咽手术路在何方——OSA舌咽手术的进展与困惑
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摘要
<正>OSA是一种在睡眠期间上气道反复发生塌陷狭窄阻塞,出现打鼾、呼吸暂停和间歇低氧血症的常见睡眠呼吸障碍性疾病。OSA是多种慢性病的源头性疾病,可导致心脑血管和代谢性疾病,甚至发生睡眠猝死。成人OSA发病机制较为复杂,上气道解剖性狭窄、舌肥大松弛后坠和神经调控功能下降是成人舌咽平面塌陷阻塞的主要病因~([1])。针对舌咽平面的手术方法众多,但仍有诸多缺陷,疗效好的手术方法创伤较大,而创伤较小的手术疗效又常不满意,甚至难以预测~([2])。同一种单一平面
引文
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[2]KEZIRIAN E J,HOHENHORST W,DE VRIES N.Drug-induced sleep endoscopy:the VOTE classification[J].Eur Arch Otorhinolaryngol,2011,268:1233-1236.
[3]POWELL N B,RILEY R W,GUILLEMINAULT C.Radiofrequency tongue base reduction in sleep-disordered breathing:apilot study[J].Otolaryngol Head Neck Surg,1999,120:656-664.
[4]STUCK B A,MAURER J T,VERSE T,et al.Tongue base reduction with temperature controlled radiofrequency volumetric tissue reduction for treatment of obstructive sleep apnea syndrome[J].Acta Otolaryngol,2002,122:531-536.
[5]FRIEDMAN M,IBRABIM H,LEE G,et al,Combined uvulopalatopharyngoplasty and radiofrequency tongue base reduction for treatment of obstructive sleep apnea/hypopnea syndrome[J].Otolaryngol Head Neck Surg,2003,129:611-612.
[6]OMUR M,OZTURAN D,ELEZ F,Tongue base suspension combined with UPPP in severe OSA patients[J].Otolaryngol Head Neck Surg,2005,133:218-219.
[7]TSOU Y A,HUANG C W,WU T F,et al.The effect of tongue base suspension with uvulopalatopharyngoplasty on sleep quality in obstructive sleep apnea[J].Sci Rep,2018,8:87-88.
[8]HANDLER E,HAMANS E,GOLDBERG A N,et al,Tongue suspension:an evidence-based review and comparison to hypopharyngeal surgery for OSA[J].Laryngoscope,2014,124:329-336.
[9]WOODSON B T,STEWARD D L,MICKELSON S,et al,Multicenter study of a novel adjustable tongueadvancement device for obstructive sleep apnea[J].Otolaryngol Head Neck Surg,2010,143:585-587.
[10]KOCDOR P,FROYMOVICH O,MICKELSON S,et al.Tongue base suspension procedures for obstructive sleep apnea syndrome[J].Oper Tech Otolaryngol,2015,26:187-192.
[11]GILLIS E,RAMPERSAUD C,PEASE E,et al.A novel implantable device for a minimally invasive surgical treatment of obstructive sleep apnea:design and preclinical safety assessment[J].Nature Sci Sleep,2016,8:249-258.
[12]PAVELEC V,ROTENBERG B W,MAURER J T,et al,A novel implantable device for the treatment of obstructive sleep apnea:clinical safety and feasibility[J].Nature Sci Sleep,2016,8:137-144.
[13]RILEY R W,POWELL N B,GUILLEMINAULT C.Obstructive sleep apnea and the hyoid:a revised surgical procedure[J].Otolaryngol Head Neck Surg,1994,111:717-721.
[14]HAMANS E,STUCK B A,DE VRIES N,et al.Hyoid expansion as a treatment for obstructive sleep apnea:apilot study[J].Sleep Breath,2013,17:195-201.
[15]SONG S A,WEI J M,BUTTRAM J.Hyoid surgery alone for obstructive sleep apnea:A systematic review and meta-analysis[J].Laryngoscope,2016,126:1702-1708.
[16]FUJITA S,WOODSON B T,CLARK J L,et al.Laser midline glossectomy as a treatment for obstructive sleep apnea[J].Laryngoscope,1991,101:805-809.
[17]WOODSON B T.Innovative technique for lingual tonsillectomy and midline posterior glossectomy for obstructive sleep apnea[J].Oper Tech Otolaryngol,2007,18:20-28.
[18]FRIEDMAN M,ROHIT S,BERK G,et al.Evaluation of submucosal minimally invasive lingual excision technique for treatment of obstructive sleep apnea/hypopnea syndrome[J].Otolaryngol Head Neck Surg,2008,139:378-384.
[19]MATURO S C,USAF C,ERIC A.et al,Submucosal minimally invasive lingual excision(SMILE):Technique for tongue base reduction[J].Oper Tech Otolaryngol,2007,18:29-32.
[20]WOODSON B T,SUPAWAN L.Lingual tonsillectomy and midline posterior glossectomy for obstructive sleep apnea[J].Oper Tech Otolaryngol,2012,23:155-161.
[21]GUNAWARDENA I,ROBINSON S,MACKAY S.Submucosal lingualplasty for adult obstructive sleep apnea[J].Otolaryngol Head Neck Surg,2013,148:157-165.
[22]ROBINSON S,KRISHNA S,CHARLES J,et,al.Conventional tongue base volumetric reduction for obstructive sleep apnea[J].Oper Tech Otolaryngol,2012,23:36-44.
[23]MURPHEY A W,KANDL J A,NGUYEN S A,et al.The effect of glossectomy for obstructive sleep apnea:a systematic review and meta-analysis[J].Otolaryngol Head Neck Surg,2015,153:334-342.
[24]FRIEDMAN M,HAMILTON C,SAMUELSON CG,et al,Transoral robotic glossectomy for the treatment of obstructive sleep apnea-hypopnea syndrome[J].Otolaryngol Head Neck Surg,2012,146:854-862.
[25]LEE J M,WEINSTEIN G S,O'MALLEY B W Jr,et al.Transoral robot-assisted lingual tonsillectomy and uvulopalatopharyngoplasty for obstructive sleep apnea[J].Ann Otol Rhinol Laryngol,2012,121:635-639.
[26]VICINI C,MONTEVECCHI F,CAMPANINI A,et al,Clinical outcomes and complications associated with TORS for OSAHS:a benchmark for evaluating an emerging surgical technology in a targeted application for benign disease[J].ORL,2014,76:63-69.