The Role of the Genial Bone Advancement Trephine System in Conjunction with Uvulopalatopharyngoplasty in the Multilevel Management of Obstructive Sleep Apnea
The Role of the Genial Bone Advancement Trephine System in Conjunction with Uvulopalatopharyngoplasty in the Multilevel Management of Obstructive Sleep Apnea
复制标题
DOI：
10.1016/j.otohns.2003.09.015
复制
发表时间：
2004-01
期刊：
影响因子：
--
通讯作者：
F. R. Miller;D. Watson;M. Boseley
中科院分区：
文献类型：
--
作者：
F. R. Miller;D. Watson;M. Boseley
目的：阻塞性睡眠呼吸暂停(OSA)的成功外科治疗需要同时处理腭后和舌后呼吸道阻塞的外科手术。膝状骨推进环钻系统(GBAT)是一种新型的一步式系统，允许通过引导环钻系统分离和推进颧舌肌。本项目的目的是描述我们使用GBAT系统联合悬雍垂腭咽成形术(UPPP)治疗OSA的经验。研究设计：回顾分析1999年至2002年连续35例使用GBAT系统联合UPPP治疗OSA的患者。结果：24例患者有完整的术前和术后多导睡眠图资料。呼吸紊乱指数和呼吸暂停指数较术前下降70%(呼吸紊乱指数分别为52.9±17.1和15.9±7.5，呼吸暂停指数分别为2 0.1±6.7和6.1±4.5，P≤0.0001)。最低氧减饱和度从80%增加到88%(P=0.0002)，后气道由7.9mM增加到12.6mM(P<；0.0001)。手术治愈定义为RDI减少50%以上，术后RDI每小时小于20次，真正的手术治愈率为67%(16/24例)。结论：GBAT系统联合UPPP可显著降低RDI和AI，同时改善氧减饱和度，扩大后气道间隙。使用GBAT系统的有效治愈率与文献中使用各种GGA技术的报告一致。GBAT在简单性和安全性方面可能有一些优势。
OBJECTIVES: The successful surgical management of obstructive sleep apnea (OSA) requires surgical procedures that address both retropalatal and retrolingual airway obstruction. The Genial Bone Advancement Trephine (GBAT) system is a new, 1-step system that allows for isolation and advancement of the genioglossus muscle via a guided trephine system. The purpose of this project was to describe our experience using the GBAT system to perform genioglossus advancement (GGA) in conjunction with uvulopalatopharyngoplasty (UPPP) in the surgical management of OSA.STUDY DESIGN:Retrospective analysis of 35 consecutive patients undergoing GGA using the GBAT system in conjunction with UPPP for the management of OSA during a 3-year period (1999 to 2002).RESULTS:Twenty-four patients had complete preoperative and postoperative polysomnographic data. A 70% reduction in the Respiratory Disturbance Index (RDI) and Apnea Index (AI) in the preoperative versus postoperative PSG (RDI, 52.9 ± 17.1 versus 15.9 ± 7.5; AI, 20.1 ± 6.7 versus 6.1 ± 4.5;P≤ 0.0001). The lowest oxygen desaturation increased from 80% to 88% (P= 0.0002), and the posterior airway increased from 7.9 to 12.6 mm (P< 0.0001). With a surgical cure defined as a greater than 50% reduction in the RDI and a final postoperative RDI of less than 20 events per hour, the true surgical cure rate was 67% (16 of 24 patients).CONCLUSIONS:The GBAT system performed in conjunction with UPPP can produce significant reductions in RDI and AI while improving the oxygen desaturation and enlarging the posterior airway space. The effective cure rates using the GBAT system are in agreement with previous reports in the literature using various GGA techniques. The GBAT may have some advantages in terms of simplicity and safety.