外展悬吊缝合技术在阻塞性睡眠呼吸暂停治疗中的改良及应用进展

doi:10.6040/j.issn.1673-3770.0.2024.507

摘要/Abstract

摘要： 阻塞性睡眠呼吸暂停是一种以睡眠打鼾、呼吸暂停及日间嗜睡为主要临床表现的睡眠呼吸疾病。目前对于不耐受持续气道正压通气治疗且存在口咽部阻塞的患者,临床通常采取悬雍垂腭咽成形术。最新研究认为,咽侧壁是阻塞气流的关键点。因此众多学者以此为依据,对手术方式加以改良或重新设计,以期更有效地扩大咽腔横截面积、降低阻塞性睡眠呼吸暂停的严重程度、减少患者的不适感和并发症。本文着重围绕当下针对咽侧壁实施的外展悬吊缝合技术展开综述,旨在探讨如何在实现最小损伤的基础上,最大程度地扩大咽侧壁,改善阻塞性睡眠呼吸暂停患者的症状,并降低术后并发症,进而为相关临床治疗工作提供有益参考。

关键词: 阻塞性睡眠呼吸暂停, 悬雍垂腭咽成形术, 缝合方式, 并发症

Abstract: Obstructive sleep apnea is a sleep-related breathing disorder characterized primarily by symptoms such as snoring, apnea, and daytime sleepiness. Currently, for patients who do not tolerate continuous positive airway pressure ventilation and have oropharyngeal obstruction, the clinic usually adopts suspensory palatopharyngoplasty. Nevertheless, recent studies have identified the lateral pharyngeal wall as the crucial point of obstruction to airflow. Consequently, many scholars have used this as a basis for improving or redesigning the surgical approach in order to expand the cross-sectional area of the pharyngeal cavity, reduce the severity of obstructive sleep apnea, and minimize patients' discomfort and complications. This article focuses on the current abduction suspension suture technique for the lateral pharyngeal wall, aiming to explore how to maximize the expansion of the lateral pharyngeal wall with minimal damage, improve the symptoms of patients with obstructive sleep apnea, and reduce postoperative complications, thus providing a useful reference for the relevant clinical treatment work.

Key words: Obstructive sleep Apnea, Uvulopalatopharyngoplasty, Suture, Complications

中图分类号:

R766.9

马馨,董凌康,吴红敏,易红良,邹建银. 外展悬吊缝合技术在阻塞性睡眠呼吸暂停治疗中的改良及应用进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 81-88.

MA Xin, DONG Lingkang, WU Hongmin, YI Hongliang, ZOU Jianyin. Modifications and applications of lateral expansion abduction suspension suture technique in the treatment of obstructive sleep apnea[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(3): 81-88.

参考文献

[1] Platon AL, Stelea CG, Boi\u0219teanu O, et al. An update on obstructive sleep apnea syndrome-a literature review[J]. Medicina, 2023, 59(8): 1459. doi:10.3390/medicina59081459
[2] Redline S, Azarbarzin A, Peker Y. Obstructive sleep apnoea heterogeneity and cardiovascular disease[J]. Nat Rev Cardiol, 2023, 20(8): 560-573. doi:10.1038/s41569-023-00846-6
[3] 任晓勇. 阻塞性睡眠呼吸暂停合并症的研究现状和未来展望[J]. 山东大学耳鼻喉眼学报, 2023, 37(6): 1-5. doi:10.6040/j.issn.1673-3770.0.2023.184 REN Xiaoyong. Current status and future perspectives of research on obstructive sleep apnea comorbidities[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 1-5. doi:10.6040/j.issn.1673-3770.0.2023.184
[4] Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis[J]. Lancet Respir Med, 2019, 7(8): 687-698. doi:10.1016/S2213-2600(19)30198-5
[5] Pham LV, Jun J, Polotsky VY. Obstructive sleep apnea[J]. Handb Clin Neurol, 2022, 189: 105-136. doi:10.1016/b978-0-323-91532-8.00017-3
[6] Cammaroto G, Stringa LM, Iannella G, et al. Manipulation of lateral pharyngeal wall muscles in sleep surgery: a review of the literature[J]. Int J Environ Res Public Health, 2020, 17(15): 5315. doi:10.3390/ijerph17155315
[7] Han SA, Cha H, Yang SK, et al. Sleep parameter characteristics of patients with OSA who have retropalatal circumferential narrowing and the clinical significance of lateral pharyngeal wall collapse during sleep[J]. Sleep Breath, 2023, 27(6): 2165-2173. doi:10.1007/s11325-023-02808-1
[8] Zhang C, Chen MX, Shen YE, et al. Impact of upper airway characteristics on disease severity and CPAP therapy in Chinese patients with OSA: an observational retrospective study[J]. Front Neurol, 2022, 13: 767336. doi:10.3389/fneur.2022.767336
[9] 林乐阳. 药物诱导睡眠内镜检查的鼾症患者不同部位塌陷情况与低氧血症相关性[J]. 当代医学, 2022, 28(6): 82-85. doi:10.3969/j.issn.1009-4393.2022.06.029 LIN Leyang. Correlation between different site collapse and hypoxia in snoring patients undergoing drug-induced sleep endoscopy[J]. Contemporary Medicine, 2022, 28(6): 82-85. doi:10.3969/j.issn.1009-4393.2022.06.029
[10] Melanie Lyons M, Bhatt NY, Pack AI, et al. Global burden of sleep-disordered breathing and its implications[J]. Respirology, 2020, 25(7): 690-702. doi:10.1111/resp.13838
[11] de Batlle J, Gracia-Lavedán E, Escarrabill J, et al. Effect of CPAP treatment on cardiovascular outcomes[J]. Arch Bronconeumol, 2024, 60(10): 627-633. doi:10.1016/j.arbres.2024.05.029
[12] Zhan XJ, Li L, Wu C, et al. Effect of uvulopalatopharyngoplasty(UPPP)on atherosclerosis and cardiac functioning in obstructive sleep apnea patients[J]. Acta Otolaryngol, 2019, 139(9): 793-797. doi:10.1080/00016489.2019.1633475
[13] Martin AM, Elliott Z, Mastrolonardo E, et al. Long term cardiovascular outcomes between sleep surgery and continuous positive airway pressure[J]. Ann Otol Rhinol Laryngol, 2024, 133(12): 1019-1028. doi:10.1177/00034894241284169
[14] Chang JL, Goldberg AN, Alt JA, et al. International consensus statement on obstructive sleep apnea[J]. Int Forum Allergy Rhinol, 2023, 13(7): 1061-1482. doi:10.1002/alr.23079
[15] Vlad AM, Stefanescu CD, Stefan I, et al. Comparative efficacy of velopharyngeal surgery techniques for obstructive sleep apnea: a systematic review[J]. Medicina, 2023, 59(6): 1147. doi:10.3390/medicina59061147
[16] 易星, 邓腾波. 扁桃体低温等离子融切术后出血的相关危险因素分析[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(5): 407-410. doi:10.13201/j.issn.1001-1781.2019.05.006 YI Xing, DENG Tengbo. Analysis of risk factors for postoperative haemorrhage following coblation-assisted tonsillectomy[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2019, 33(5): 407-410. doi:10.13201/j.issn.1001-1781.2019.05.006
[17] Fushimi K, Gyo K, Okunaka M, et al. Analysis of risk factors for post-tonsillectomy hemorrhage in adults[J]. Auris Nasus Larynx, 2023, 50(3): 389-394. doi:10.1016/j.anl.2022.10.002
[18] Ren LH, Li J, Miao ZY, et al. The application of gargle containing honeysuckle and Semen oroxyli to reduce the pain and complications after uvulopalatopharyngoplasty[J]. Front Pharmacol, 2022, 13: 974233. doi:10.3389/fphar.2022.974233
[19] Abdelwahab M, Marques S, Previdelli I, et al. Perioperative antibiotic use in sleep surgery: clinical relevance[J]. Otolaryngol Head Neck Surg, 2022, 166(5): 993-1002. doi:10.1177/01945998211048745
[20] Aksoy EA, Serin GM, Polat S, et al. Comparison of postoperative bleeding between submucosal uvulopalatopharyngoplasty and tonsillectomy[J]. J Res Med Sci, 2014, 19(4): 310-313
[21] Molnár V, Molnár A, Lakner Z, et al. The prognostic role of ultrasound and magnetic resonance imaging in obstructive sleep apnoea based on lateral oropharyngeal wall obstruction[J]. Sleep Breath, 2023, 27(1): 319-328. doi:10.1007/s11325-022-02597-z
[22] Huon LK, Liu SY, Shih TT, et al. Dynamic upper airway collapse observed from sleep MRI: BMI-matched severe and mild OSA patients[J]. Eur Arch Otorhinolaryngol, 2016, 273(11): 4021-4026. doi:10.1007/s00405-016-4131-1
[23] AU Chunting, CHAN KCC, ZHANG Jihui, et al. Intermediate phenotypes of childhood obstructive sleep apnea [J]. J Sleep Res, 2021, 30(3): 13191. doi:10.1111/jsr.13191
[24] Yuen HM, Lai ACY, Liu EKH, et al. Validation of the Sonographic Measurement of Lateral Parapharyngeal Wall Thickness in Childhood Obstructive Sleep Apnea [J]. Nat Sci Sleep, 2022, 14: 2013-2021. doi:10.2147/nss.S369727
[25] 韩德民, 王军, 叶京英, 等. 腭咽成形术中保留悬雍垂的意义[J]. 中华耳鼻咽喉科杂志, 2000, 35(3): 215-215. doi:10.3760/j.issn:1673-0860.2000.03.015 HAN Demin, WANG Jun, YE Jingying, et al. Value of preservation of uvula in uvulopalatopharyngoplasty[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2000, 35(3): 215-215. doi:10.3760/j.issn:1673-0860.2000.03.015
[26] 陈俊, 江小燕. 改良悬雍垂腭咽成形术治疗OSAHS的临床效果[J].浙江创伤外科, 2024, 29(6):1108-1111. doi:10.3969/j.issn.1009-7147.2024.06.034
[27] 程蕾蕾, 徐艳红. 改良悬雍垂腭咽成形术对OSAHS患者睡眠及认知功能的影响[J]. 河北医科大学学报, 2024, 45(7): 766-770. doi:10.3969/j.issn.1007-3205.2024.07.005 CHENG Leilei, XU Yanhong. Effects of modified uvulopalatopharyngoplasty on sleep and cognitive function in patients with OSAHS[J]. Journal of Hebei Medical University, 2024, 45(7): 766-770. doi:10.3969/j.issn.1007-3205.2024.07.005
[28] Cahali MB. Lateral pharyngoplasty: a new treatment for obstructive sleep apnea hypopnea syndrome[J]. Laryngoscope, 2003, 113(11): 1961-1968. doi:10.1097/00005537-200311000-00020
[29] Elzayat S, El-Sobki A, El-Deeb ME, et al. Managing obstructive sleep apnea patients with CPAP failure with a novel Lateral Pharyngoplasty as a stand-alone procedure[J]. Am J Otolaryngol, 2020, 41(4): 102500. doi:10.1016/j.amjoto.2020.102500
[30] Maniaci A, Di Luca M, Lechien JR, et al. Lateral pharyngoplasty vs. traditional uvulopalatopharyngoplasty for patients with OSA: systematic review and meta-analysis[J]. Sleep Breath, 2022, 26(4): 1539-1550. doi:10.1007/s11325-021-02520-y
[31] Friedman M, Ibrahim HZ, Vidyasagar R, et al. Z-palatoplasty(ZPP): a technique for patients without tonsils[J]. Otolaryngol Head Neck Surg, 2004, 131(1): 89-100. doi:10.1016/j.otohns.2004.02.051
[32] Huang EI, Lin YC, Huang SY, et al. Shifting and reducing breathing disturbance in patients with very severe obstructive sleep apnea by modified Z-palatoplasty with one-layer closure in one-stage multilevel surgery[J]. Sci Rep, 2021, 11: 8472. doi:10.1038/s41598-021-88074-1
[33] Pang KP, Tucker Woodson B. Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea[J]. Otolaryngol Head Neck Surg, 2007, 137(1): 110-114. doi:10.1016/j.otohns.2007.03.014
[34] Pang KA, Pang KP, Lim JW, et al. Clinical outcomes of expansion sphincter pharyngoplasty-a 17-year systematic review[J]. Eur Arch Otorhinolaryngol, 2024, 281(5): 2691-2698. doi:10.1007/s00405-024-08469-4
[35] Li HY, Lee L. Relocation pharyngoplasty for obstructive sleep apnea[J]. Laryngoscope, 2009, 119(12): 2472-2477. doi:10.1002/lary.20634
[36] Li HY, Cheng WN, Chuang LP, et al. Positional dependency and surgical success of relocation pharyngoplasty among patients with severe obstructive sleep apnea[J]. Otolaryngol Head Neck Surg, 2013, 149(3): 506-512. doi:10.1177/0194599813495663
[37] Oh H, Kim HG, Pyo S, et al. The clinical efficacy of relocation pharyngoplasty to improve retropalatal circumferential narrowing in obstructive sleep apnea patients[J]. Sci Rep, 2020, 10(1): 2101. doi:10.1038/s41598-020-58920-9
[38] Sorrenti G, Pelligra I, Albertini R, et al. Functional expansion pharyngoplasty: Technical update by unidirectional barbed sutures[J]. Clin Otolaryngol, 2018, 43(5): 1419-1421. doi:10.1111/coa.13105
[39] Sorrenti G, Piccin O. Functional expansion pharyngoplasty in the treatment of obstructive sleep apnea[J]. Laryngoscope, 2013, 123(11): 2905-2908. doi:10.1002/lary.23911
[40] 李志英. 功能性扩张咽成形术对重度阻塞性睡眠呼吸暂停低通气综合征的疗效分析[D]. 南华大学, 2022
[41] Emara TA, Hassan MH, Mohamad AS, et al. Anterolateral advancement pharyngoplasty: a new technique for treatment of obstructive sleep apnea[J]. Otolaryngol Head Neck Surg, 2016, 155(4): 702-707. doi:10.1177/0194599816648127
[42] Askar SM, El-Bary MEA, Elshora ME, et al. Anterolateral advancement palatoplasty with tonsillectomy for retropalatal obstruction in selected cases of obstructive sleep apnea[J]. Eur Arch Otorhinolaryngol, 2022, 279(5): 2679-2687. doi:10.1007/s00405-021-07235-0
[43] Emara TA, Elmonem MSAA, Khaled AM, et al. Anterolateral advancement pharyngoplasty versus barbed reposition pharyngoplasty in patients with obstructive sleep apnea[J]. Eur Arch Otorhinolaryngol, 2024, 281(4): 1991-2000. doi:10.1007/s00405-023-08402-1
[44] Jun H. A new treatment for snoring: sling snoreplasty with a permanent thread[J]. Acta Otolaryngol, 2008, 128(12): 1381-1384. doi:10.1080/00016480801968500
[45] Iannella G, Lechien JR, Perrone T, et al. Barbed reposition pharyngoplasty(BRP)in obstructive sleep apnea treatment: state of the art[J]. Am J Otolaryngol, 2022, 43(1): 103197. doi:10.1016/j.amjoto.2021.103197
[46] Vicini C, Hendawy E, Campanini A, et al. Barbed reposition pharyngoplasty(BRP)for OSAHS: a feasibility, safety, efficacy and teachability pilot study. “we are on the giant's shoulders”[J]. Eur Arch Otorhinolaryngol, 2015, 272(10): 3065-3070. doi:10.1007/s00405-015-3628-3
[47] Lombo C, Costa R, Martins M, et al. Pharyngoplasty for obstructive sleep apnea: the influence of surgical technique[J]. Acta Otorrinolaringol Esp, 2022, 73(6): 362-369. doi:10.1016/j.otoeng.2021.11.004
[48] 韩继波, 罗志宏, 董洁, 等. 倒刺线软腭咽侧悬吊咽成形联合改良悬雍垂腭咽成形术治疗OSAHS患者疗效分析[J]. 中华耳鼻咽喉头颈外科杂志, 2023, 58(10):959-965. doi:10.3760/cma.j.cn115330-20221202-00725 HAN Jibo, LUO Zhihong, DONG Jie, et al. Efficacy of Barbed reposition pharyngoplasty combined with Han-Uvulopalatopharyngoplasty for the treatment of OSAHS patients[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2023, 58(10): 959-965. doi:10.3760/cma.j.cn115330-20221202-00725
[49] El-Ahl MAS, El-Anwar MW. Expansion pharyngoplasty by new simple suspension sutures without tonsillectomy[J]. Otolaryngol Head Neck Surg, 2016, 155(6): 1065-1068. doi:10.1177/0194599816669501
[50] El-Anwar MW, Askar S, El-Sinbawy AH, et al. Single versus double suspension sutures for selected cases of obstructive sleep apnea[J]. Auris Nasus Larynx, 2019, 46(5): 754-757. doi:10.1016/j.anl.2018.12.014
[51] 陈彩凤, 张湘民, 朱任良, 等. 移位-线牵拉扩张咽成形术治疗软腭口咽阻塞为主的OSAHS的疗效研究[J]. 中华耳鼻咽喉头颈外科杂志, 2021, 56(12): 1270-1276. doi:10.3760/cma.j.cn115330-20210707-00436 CHEN Caifeng, ZHANG Xiangmin, ZHU Renliang, et al. Efficacy of relocation and expansion pharyngoplasty by suspension sutures in the treatment of OSAHS with soft palate oropharyngeal obstruction[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2021, 56(12): 1270-1276. doi:10.3760/cma.j.cn115330-20210707-00436
[52] Askar SM, El-Anwar MW. Double suspension sutures: a simple surgical technique for selected cases of obstructive sleep apnoea: our experience with twenty-two patients[J]. Clin Otolaryngol, 2018, 43(2): 753-757. doi:10.1111/coa.13056
[53] Lu YT, Tai SK, Lee TL. Pterygomandibular suspension suture: a simple modification of uvulopalatopharyngoplasty for severe obstructive sleep apnea[J]. Eur Arch Otorhinolaryngol, 2018, 275(1): 269-273. doi:10.1007/s00405-017-4773-7
[54] Jo KH, Choi DG, Lee WG, et al. Palatopharyngeal muscle suspension suture technique for patients with obstructive sleep apnea[J]. Am J Otolaryngol, 2022, 43(6): 103560. doi:10.1016/j.amjoto.2022.103560
[55] Li HY, Tsai MS, Lee L, et al. Palatal hybrid surgery for obstructive sleep apnea-state-of-the-art annotation of uvulopalatopharyngoplasty[J]. Biomed J, 2023, 46(3): 100568. doi:10.1016/j.bj.2022.11.001
[56] Fujita S, Conway W, Zorick F, et al. Surgical correction of anatomic azbnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty[J]. Otolaryngol Head Neck Surg, 1981, 89(6): 923-934. doi:10.1177/019459988108900609

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed