Lateral pharyngoplasty: A new treatment for obstructive sleep apnea hypopnea syndrome
Lateral pharyngoplasty: A new treatment for obstructive sleep apnea hypopnea syndrome
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DOI：
10.1097/00005537-200311000-00020
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发表时间：
2003-11-01
期刊：
影响因子：
2.6
通讯作者：
Cahali, MB
中科院分区：
文献类型：
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作者：
Cahali, MB
目的：探讨咽外侧肌壁在阻塞性睡眠呼吸暂停低通气综合征（OSAHS）发病中的作用。我的目的是描述OSAHS患者咽侧壁夹板的外科手术，并报告初步结果。研究设计：作为博士论文的一部分，在学术高等教育中心进行前瞻性随机试点研究。患者和方法：10名成年OSAHS患者，最初选择用悬垂腭咽成形术治疗，接受了侧咽成形术，包括扁桃体窝内咽上收缩肌的显微解剖，该肌肉切片，并将该肌肉的外侧基瓣缝合到同侧腭舌肌上。此外，进行腭咽z形成形术以防止腭后塌陷。结果：侧咽成形术改善了OSAHS患者的睡眠和白天症状。随访至少6个月后，呼吸暂停低通气指数中位数从41.2下降到9.5 (P = 0.009)，快速眼动（REM）睡眠和第3 + 4阶段非REM睡眠的中位数总睡眠时间分别从14.1%增加到22.1% （P = 0.059）和从5.3%增加到16.3% （P = 0.037）。此外，在打鼾、白天嗜睡和该病对生活质量的总体影响方面也有统计学上的显著改善。术后吞咽障碍平均持续14.5天，随访中所有患者主观吞咽功能均恢复正常。结论：咽外侧成形术是一种安全、直接的咽外侧肌修复方法，对OSAHS患者有明显的疗效。
Objective: The role of the lateral pharyngeal muscular walls in the pathogenesis of obstructive sleep apnea hypopnea syndrome (OSAHS) is crucial. My objective is to describe a surgical procedure for splinting the lateral pharyngeal walls in patients with OSAHS and report the initial results. Study Design: Prospective randomized pilot study performed in an academic tertiary center as part of a doctoral thesis. Patients and Methods: Ten adults with OSAHS, originally selected for treatment with uvulopalatopharyngoplasty, underwent the lateral pharyngoplasty procedure, which consists of a microdissection of the superior pharyngeal constrictor muscle within the tonsillar fossa, sectioning of this muscle, and suturing of the created laterally based flap of that muscle to the same-side palatoglossus muscle. In addition, a palatopharyngeal Z-plasty is performed to prevent retropalatal collapse. Results: Lateral pharyngoplasty improved sleep and daytime symptoms related to OSAHS. After at least 6 months of follow-up, the median apnea-hypopnea index decreased from 41.2 to 9.5 (P = .009) and the median total sleep time spent in rapid eye movement (REM) sleep and in stages 3 plus 4 non-REM sleep increased from 14.1% to 22.1% (P = .059) and from 5.3% to 16.3% (P = .037), respectively. Also, there was statistically significant improvement in snoring, daytime sleepiness, and overall impact of the disease on quality of life. Swallowing disturbances lasted a median of 14.5 days after the surgeries, and all patients returned to normal subjective swallowing function in the follow-up. Conclusions: Lateral pharyngoplasty is a safe and straightforward approach to lateral pharyngeal muscles and has produced appreciable benefits for OSAHS patients.