慎用鐳射輔助懸壅垂切除術可治療睡眠呼吸暫停

熱灼傷導致的傷痕將加重長期的打鼾與睡眠呼吸暫停

  2002您4月16日─4月份的《Archives of Otolaryngology -- Head and Neck Surgery》雜誌的一篇報導顯示,由於鐳射輔助懸壅垂切除術(laser-assisted uvulopalatoplasty, LAUP)導致的傷痕,實際上會加重打鼾以及睡眠呼吸暫停的長期症狀。

   LAUP短期個人感覺的治療效果很好,但這種情況隨時間延長而逐漸惡化, 以色列Kfar Saba的Sapir醫學中心的Yehuda Finkelstein醫師及其同事們寫道:「術後多睡的症狀顯示,LAUP可能會使當前的呼吸暫停進一步惡化。」

  此次非隨機化前瞻性自身對照研究中,有26位阻塞性睡眠呼吸暫停的患者進行了LAUP,在懸壅垂兩側放置了垂直通氣管,並進行了懸壅垂削減。

  儘管在手術後4周時,23位患者提到打鼾的症狀有所改善,但術後長期隨訪(12.3 + 9.1個月)發現,只有17位患者這種症狀改善得以保持。在四個周時,有4%的患者打鼾比手術前更嚴重,而在長期隨訪中,則由12%的患者報告打鼾比手術前更嚴重。長期隨訪中,有半數患者自稱五項其他的睡眠相關症狀得到了改善,但15%的患者自稱這些症狀有所惡化。

  此手術總體滿意率為58%,54%的患者感覺持續咽幹。術後客觀性研究顯示只有31%(8/26)的患者睡眠呼吸暫停的症狀得到了改善,有31%的患者respiratory disturbance index指標惡化。有一位患者發生上咽部狹窄

   這些結果可能與由雷射光束引起的上咽部變窄以及進展性上顎纖維化有關,作者寫道:「此處存在的事實值得關注,並且提示LAUP也許並不是治療阻塞性睡眠呼吸暫停的適宜的方法。」

  2002年美國睡眠研究院提出,根據文獻綜述的結果,不推薦使用LAUP作為睡眠呼吸暫停的治療方法。

Beware of Laser-Assisted Uvuloplasty for Sleep Apnea

Heat Scarring May Worsen Snoring, Apnea in the Long Term

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Gary D. Vogin, MD

Apr 16, 2002 -- Scarring from laser-assisted uvulopalatoplasty (LAUP) may actually worsen long-term symptoms of snoring and sleep apnea, according to a report in the April issue of the Archives of Otolaryngology -- Head and Neck Surgery.

"The favorable subjective short-term results of LAUP deteriorated in time," write Yehuda Finkelstein, MD, and colleagues from Sapir Medical Center in Kfar Saba, Israel. "Postoperative polysomnography revealed that LAUP might lead to deterioration of existing apnea."

In this nonrandomized, prospective, before-after trial, 26 patients with obstructive sleep apnea had LAUP with placement of vertical trenches along either side of the uvula and reduction of the uvula.

Although 23 patients (88%) reported improvement in snoring four weeks after surgery, only 17 (65%) maintained improvement at long-term postoperative follow-up (12.3 + 9.1 months). Snoring was worse than before surgery in 4% of patients at 4 weeks and in 12% of patients at long-term follow-up. Half of patients reported improvement in 5 other sleep-related symptoms at long-term follow-up, but 15% (4/26) reported worsening in these symptoms.

Overall satisfaction rate with the surgery was 58%, and 54% had a persistent sensation of pharyngeal dryness. Postoperative objective studies showed resolution of sleep apnea in only 31% (8/26), and worsening of respiratory disturbance index in 31%. One patient developed velopharyngeal stenosis.

"These findings are probably related to velopharyngeal narrowing and progressive palatal fibrosis inflicted by the laser beam," the authors write. "The facts presented herein are cause for concern and suggest that LAUP might not be an appropriate procedure to treat obstructive sleep apnea."

In 2000, the American Academy of Sleep stated that, based on a review of the literature, "LAUP is not recommended for the treatment of obstructive sleep apnea."

© 2002 WebMD Inc. All rights reserved.

    
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