經口機械手臂執行睡眠呼吸中止症術後的短期吞嚥情形與嗆咳風險

Short-term Risk of Dysphagia and Choking after Transoral Robotic Surgery for Patients of Obstructive Sleep Apnea

楊少槐(Shau-Huai Yang) ； 溫惟昇(Wei-Sheng Wen) ； 曹傑漢(Chien-Han Tsao) ； 蘇茂昌(Mao-Chang Su) ； 辛宗翰(Chung-Han Hsin)

《台灣耳鼻喉頭頸外科雜誌》 52卷4期 (2017/12) Pp. 131-139

https://doi.org/10.6286/2017.52.4.131

摘要

背景：睡眠呼吸中止症並非惡性疾病，若以手術治療需預期患者對手術後症狀的忍受度。以經口機械手臂治療睡眠呼吸中止症已是常規的手術，本研究的目的在比較經過傳統懸壅垂顎咽成形術加上經口機械手臂舌根縮減術的患者，術後吞嚥功能是否較單純接受懸壅垂顎咽成形術的患者差。並觀察患者的吞嚥症狀變化。方法：收集15名睡眠呼吸中止症患者，實施懸壅垂顎咽成形術並以經口機械手臂執行舌根縮減術，此為實驗組。測量患者切除下來的舌根組織重量，以中文版飲食評估工具量表(Eating Assessment Tool, EAT-10)評估患者手術後2到6週的情形，此為實驗組。對照組為另外10名重度睡眠呼吸中止症患者，僅執行懸壅垂顎咽成形術，亦以中文版飲食評估工具量表評估患者手術後2到6週的情形。兩組均於術後3個月再次接受睡眠多項生理檢查(polygomnography, PSG)。結果：15名患者平均切除舌根重量7.26 ± 5.63 gm，成對樣本t檢定顯示睡眠呼吸障礙指數(apnea hyponea index)，快速動眼期睡眠百分比，驚醒指數(arousal index)最低血氧濃度(lowest SaO2)與鼾聲指標(snoring index)在手術前後呈現有意義的變化(p ＜ 0.05)。描述形統計顯示飲食評估工具量表在前3週的總分仍然大於15分。但第4週平均降到9.64 ± 5.53分。相關性統計方面採Spearman's檢定，結果顯示實驗組切除的舌根重量與手術前後睡眠呼吸障礙指數變化呈正相關性。結論：經口機械手臂手舌根縮減手術後的吞嚥困難情形在手術後3週持續存在，且較單純執行懸壅垂顎咽成形術之對照組明顯，但通常1個月後吞嚥困難症狀會得到改善。

關鍵字

swallowing ； transoral robotic surgery for volume reduction on base of tongue ； uvulopalatopharyngoplasty ； obstructive sleep apnea syndrome（吞嚥，經口機械手臂舌根縮減術，懸壅垂顎咽成形術，阻塞性睡眠呼吸中止症）

並列摘要

BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by repetitive episodes of apnea or reduced inspiratory airflow due to upper airway obstruction during sleep. Before surgery for patients of OSA, we must take postoperative complications into consideration. Uvolopalatopharyngoplasty (UPPP) is the current gold standard for surgical intervention for OSA. Transoral robotic surgery (TORS) for OSA is a newer surgical technique that can potentially reduce postoperative complications for UPPP. The purpose of our study is to compare the swallowing function outcomes of patients that underwent TORS-assisted UPPP and base of tongue reduction with the outcomes of patients treated with traditional UPPP. METHOD: 15 patients of OSA underwent TORS-assisted UPPP and base of tongue reduction. Meanwhile, 10 patients underwent traditional UPPP as a control group. The weight of the resected base of tongue was measured. We evaluated the swallowing function by the Eating Assessment Tool (EAT-10) from post-operative week 2 to 6. Both groups underwent a repeat polypsomnography (PSG) 3 months after operation. RESULTS: The mean weight of resected base of tongue is 7.26 ± 5.63 gm. The apnea-hypopnea index (AHI), first third sleep time, and arousal index of the TORS-assisted UPPP and base of tongue reduction had statistically significant results when compared with the UPPP only control group (P values ＜ 0.05). The EAT-10 mean score of the TORS-assisted surgery was more than 15 points in the first 3 weeks after surgery. However the mean score of EAT-10 decreased to 9.64 ± 5.53 after week 4. Spearman's test also revealed that the weight of resected base of tongue has positive correlation with the decrease of AHI value. CONCLUSION: Dysphagia was more severe in the first 3 weeks in patients undergoing TORS-assisted UPPP and base of tongue reduction when compared to the UPPP only group. However, dysphagia symptoms typically subsided 1 month after operation.

並列關鍵字

swallowing ； transoral robotic surgery for volume reduction on base of tongue ； uvulopalatopharyngoplasty ； obstructive sleep apnea syndrome