The Role of Obstruction Length and Height in Predicting Outcome of Velopharyngeal Surgery
The Role of Obstruction Length and Height in Predicting Outcome of Velopharyngeal Surgery
复制标题
梗阻长度和高度在预测腭咽手术结果中的作用。
DOI：
10.1177/0194599815576719
复制
发表时间：
2015-07-01
影响因子：
3.4
通讯作者：
Kang, Dan
中科院分区：
文献类型：
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作者：
Zhang, Peng;Ye, Jingying;Kang, Dan
目的应用药物诱导睡眠内窥镜(DISE)测量阻塞性睡眠呼吸暂停(OSA)患者的阻塞长度和高度，并评价其与腭咽闭合手术疗效的关系。研究设计前瞻性队列研究。术前用DISE和压力传感器导管法测量阻塞长度(定义为塌陷最上端到塌陷最下端的距离)和阻塞高度(定义为鼻中隔后缘到塌陷最近端的距离)。所有患者均接受了腭咽成形术，包括保留悬雍垂的改良悬雍垂腭咽成形术和经腭咽成形术。结果有效26例(60.5%)，无反应17例(39.5%)。平均阻塞长度1.3±0.5 cm(0.4~2.2 cm)，平均阻塞高度3.4±0.9 cm(1.1~5.0 cm)。无反应者的梗阻长度较长，梗阻数值较短。多因素Logistic回归分析显示，阻塞长度和阻塞高度分别为1.4 cm(优势比[OR]，0.21；95%可信区间[CI]，0.04~0.98；P=0.048)和3.2 cm(优势比9.35；95%CI，1.79~48.80；P=0.008)是影响腭咽闭合手术成功的独立危险因素。这两个参数可以预测腭咽闭合手术的疗效。
Objective To measure obstruction length and height using drug-induced sleep endoscopy (DISE) in obstructive sleep apnea (OSA) patients and to evaluate their association with outcomes of velopharyngeal surgery.Study Design Prospective cohort study.Setting University medical center.Methods Forty-three consecutive patients with OSA were evaluated by DISE using dexmedetomidine. The 2 new parameters, obstruction length (defined as the distance from the most superior point of the collapse to the most inferior point of the collapse) and obstruction height (the distance from the posterior border of the nasal septum to the most proximal point of the collapse), were measured by both DISE and a pressure transducer catheter method before surgery. All of the patients received velopharyngeal surgery, including revised uvulopalatopharyngoplasty with uvula preservation and transpalatal advancement pharyngoplasty. We followed up with all of the patients using polysomnography at least 3 months after surgery.Results Twenty-six (60.5%) patients were responders, and 17 (39.5%) were nonresponders. The mean obstruction length and obstruction height were 1.3 0.5 cm (range, 0.4-2.2 cm) and 3.4 +/- 0.9 cm (range, 1.1-5.0 cm), respectively. Nonresponders had a longer obstruction length and a shorter obstruction value. Multivariate logistic regression analysis revealed that obstruction length >1.4 cm (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.04-0.98; P = .048) and obstruction height 3.2 cm (OR, 9.35; 95% CI, 1.79-48.80; P = .008) were the only independent predictors of velopharyngeal surgery success.Conclusions Accurate measurement of obstruction length and height can be performed with both DISE and a pressure transducer catheter method. The 2 parameters can predict the outcome of velopharyngeal surgery.