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臺灣口腔顎面外科學會雜誌

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篇名 改良式懸壅垂腭咽整形術:手術方式及單一部門追蹤之三年結果
卷期 33:1
並列篇名 Modified Uvulopalatagopharyngoplasty: Surgical Technique and 3-Year Outcomes in a Single Department
作者 蔡承熹張鈞喨張簡楨文黃麗玲柳勇全陳裕豐
頁次 013-021
關鍵字 睡眠呼吸中止症懸壅垂腭咽整形術打鼾睡眠手術Obstructive sleep apnea Relocation pharyngoplasty SnoringSleep surgery
出刊日期 202203

中文摘要

目標:自從Fujita等於1981年發表懸壅垂顎咽整形術後,多種改良型術式被提出以求更高的手術成功率並且降低術後併發症。本院採移位式咽成型術治療打鼾及睡眠呼吸中止症患者的口咽部阻塞。此篇報告的主旨是描述移位式咽成型術之手術流程及本部門之初步結果。

材料與方法:自2018年1月至2021年2月間,高雄醫學大學附設醫院口腔顎面外科執行33例移位式咽成型術(24位男性及9位女性)。移位式咽成型術的適應症包含扁桃腺肥大、打鼾、睡眠呼吸中止症、或是在藥物誘導式睡眠内視鏡檢查發現軟腭塌陷。本篇研究包含4例單純性打鼾、11例輕度睡眠呼吸中止症、5例輕度睡眠呼吸中止症、8例輕度睡眠呼吸中止症及5例扁桃腺炎患者。在移位式咽成型術後,我們使用FLOSEAL Hemostatic Matrix@增加止血效果。所有患者於術後三至六個月會安排睡眠多項生理檢查。

結果:患者術後平均住院天數爲3.9±0.9日,並無呼吸道阻塞或出血等立即性嚴重的術後併發症出現。門診追蹤期間出現延遲性的併發症包含3例(9.1%)輕度缝線膿腫、一例(3.0%)暫時性味覺改變、一例(3.0%)暫時性舌頭麻木及一例(3.0%)吸入性肺炎。在主觀的改變上Epworth睡眠分數(ESS)平均値從11.6±5.3降至7.8±3.5。睡眠呼吸中止症嚴重程度在客觀上依照睡眠報告顯示呼吸中止指數的平均値變化:輕度(術前:10.2±3.1;術後:13.2±9.4);中度(術前:25.3±5.1;術後:14.9±8.5);重度(術前:60.4±27.8;術後:20.3±24.8)。

結論:本報告提出移位式咽成型術搭配FLOSEAL Hemostatic Matrix@的使用是一個安全且可信賴的手術去治療口咽阻塞,且並未出現術後立即性的嚴重併發症。大部分的患者在打鼾及睡眠呼吸中止症的症狀上呈現正向的改善。

英文摘要

Objective: Since the introduction of uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA) in 1981, several modifications have been proposed to increase the success rate and decrease the complication rate of this surgery. We adopted relocation pharyngoplasty (RP) to treat oropharyngeal obstruction in patients with snoring and OSA. This study aimed to describe the surgical techniques of RP and the preliminary outcomes in our department.

Materials and Methods: In the Oral and Maxillofacial Department of Kaohsiung Medical University Hospital, we performed modified RP in 33 patients (24 men and nine women) from January 2018 through February 2021. Indications of RP included tonsil hypertrophy, snoring, OSA, and velum collapse under drug-induced sleep endoscopy. This study included 4 patients with primary snoring without OSA, 11 mild OSA, 5 moderate OSA, 8 severe OSA, and 5 with tonsillitis. During the RP surgery, we applied a FloSeal Hemostatic Matrix@ to cease wound bleeding. All the patients were arranged postoperative polysomography (PSG) after surgery 3to6 months.

Results: The mean hospital stay postoperatively was 3.9 ± 0.9 days. No immediate major complications, such as airway obstruction or hemorrhage, were observed in the perioperative period. During outpatient department follow-up, delayed transient complications included mild stitch abscess in 3 cases (9.1%), temporary taste change in 1 case (3.0%), temporary tongue numbness in 1 case (3.0%), and aspiration pneumonia in 1 case (3.0%). The subjective changes of mean Epworth Sleepiness Score (ESS) decreased from 11.6 ± 5.3 to 7.8 ± 3.5. The objective changes of mean apnea-hypopnea index (AHI): mild OSA (from 10.2 ± 3.1 to 13.2 ± 9.4); Moderate OSA (from 25.3 ± 5.1 to 149 ± 8.5); Severe OSA (from 60.4 ± 27.8 to 20.3 ± 24.8).

Conclusions: Results of this study showed that RP with the use of the FloSeal Hemostatic Matrix@ was a safe and reliable surgical technique to treat oropharyngeal obstruction, without any immediate major postoperative complication. Most of patients showed positive improvement of snoring or OSA symptoms.

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