經口機器手臂輔助手術治療阻塞性睡眠呼吸中止症與術後勃起功能障礙及下泌尿道症候群改善的相關性

Transoral robotic surgery for obstructive sleep apnea improves erectile dysfunction and lower urinary tract symptoms

彭致凱(Chih-Kai Peng)

指導教授 ： 李宗賢

共同指導教授 ： 陳順郎(Sung-Lang Chen)

中山醫學大學/醫學院/醫學研究所/碩士(2022年)

https://doi.org/10.6834/csmu202200066

摘要

研究目的：睡眠呼吸中止症（Obstructive sleep apnea，OSA）是一種中年男性常見的慢性疾病，本研究利用睡眠呼吸中止症手術治療前後的問卷評分改善程度了解睡眠與勃起功能障礙及下泌尿道症候群的相關性。
研究方法及資料：本研究為前瞻性研究，蒐集自西元2019年10月至2021年11月於中山醫學大學附設醫院就醫，並接受經口機器人手術（Transoral Robotic Surgery，TORS）治療及術前術後睡眠多項生理檢查（Polysomnography，PSG）之男性睡眠呼吸中止症患者，利用國際勃起功能指標量表（International Index of Erectile Function，IIEF-5）及國際攝護腺症狀評分表（International Prostate Symptom Score，IPSS）兩份問卷，經斯皮爾曼等級相關係數（Spearman's rank correlation coefficient）分析手術前後問卷分數的改善程度及相關參數變化，了解睡眠與勃起功能障礙及下泌尿道症候群的相關性。
研究結果：本前瞻性研究共收納48位男性睡眠呼吸中止症病患，平均年齡為40.6 ± 8.1歲。經過手術治療並在術後3~6個月追蹤，平均睡眠呼吸中止指數（Apnea–Hypopnea Index，AHI）從53.10 ± 25.77下降到31.66 ± 20.34（P<0.001），國際攝護腺症狀評分表（IPSS）分數從5.06 ± 5.42 降到2.98 ± 2.71（P=0.002），其中儲尿症狀分數及排尿症狀分數都有顯著改善（P<0.05），國際勃起功能指標量表（IIEF-5）也顯示勃起功能有明顯改善（平均增加1.18 ± 2.90，P=0.005）。此外，術前的睡眠呼吸中止指數（AHI）與術前的身體質量指數（Body Mass Index，BMI）有中等程度相關（rho = 0.597，P<0.001），睡眠呼吸中止指數（AHI）的改善程度與體重減輕也有中等程度相關（rho = 0.395，P=0.005），然而睡眠呼吸中止指數（AHI）的改善程度與國平均際攝護腺症狀評分表（IPSS）或國際勃起功能指標量表（IIEF-5）的分數改變沒有顯著相關性（P>0.05）。
結論與建議：經口機器人手術（Transoral Robotic Surgery，TORS）對於睡眠呼吸中止症的男性病患，在術後三個月內可減輕勃起功能障礙及下泌尿道症候群。

關鍵字

睡眠呼吸中止症 ； 經口機器人手術 ； 勃起功能障礙 ； 下泌尿道症候群

並列摘要

Objective: Obstructive sleep apnea (OSA) is a common chronic disease in the middle-aged male. The aim of this study was to evaluate changes in lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) after surgical correction of OSA by questionnaire.
Materials and Methods: This was a prospective observational study on consecutive OSA men undergoing transoral robotic surgery (TORS) in Chung Shan Medical University Hospital (CSMU) from October 2019 to November 2021. The improvement of the OSA was assessed by Polysomnography (PSG) with Apnea Hypopnea Index (AHI). Preoperative and postoperative LUTS and ED were evaluated with the International Prostate Symptom Score (IPSS) and international index of erectile function (IIEF-5) questionnaires. The changes in IPSS, IIEF and the associated factors were analyzed with Spearman correlation to realize the effects of sleep quality.
Results: This study recruited 48 men with OSA (mean age 40.6 ± 8.1 years) undergoing TORS. After surgery, there was significant AHI reduction from 53.10 ± 25.77 preoperatively to 31.66 ± 20.34 at 3-6 month postoperatively (P<0.001). There was also significant reduction in IPSS score (5.06 ± 5.42 at baseline to 2.98 ± 2.71 at 3 months postoperatively, P=0.002), storage symptom score and voiding symptom score (P<0.05). The ED improved significantly in IIEF score postoperatively (increased 1.18 ± 2.90, P=0.005). Besides, there was moderate correlation between baseline AHI and baseline BW (rho = 0.597, P<0.001). Reduction of AHI and body weight loss had moderate correlation (rho = 0.395, P=0.005). However, the reduction of AHI was not associated with improvement of IPSS or IIEF(P>0.05).
Conclusions: Transoral robotic surgery (TORS) for correction of obstructive sleep apnea (OSA) was an effective intervention for alleviating the severity of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in the period of post operation 3 months.

並列關鍵字

Obstructive sleep apnea ； Transoral robotic surgery ； Erectile dysfunction ； Lower urinary tract symptoms

參考文獻

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