Objective: To compare the therapeutic efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: This is a multicenter randomized controlled trial. From March 2017 to July 2019, moderate to severe OSAHS patients from three clinical center in Shanghai who were intolerant to continuous positive airway pressure (CPAP) and with velopharyngeal and glossopharyngeal plane obstruction were enrolled in this study. According to the surgical type, they were 1∶1 randomized to HUPPP plus radiofrequency ablation of tongue base group (Ablation group) or HUPPP plus traction of tongue base group (Traction group). All patients completed over-night standard Polysomnography (PSG), upper-airway assessment (Friedman classification, Müller test, CT and cephalometric examination), preoperative routine examination, Epworth Sleepiness Scale (ESS) and Quebec sleep questionnaire (QSQ). Six to 12 months after operation, all the above-mentioned examinations were repeatedly performed. Changes of aforementioned variables before and after operation were assessed. Results: A total of 43 patients with moderate to severe OSAHS were enrolled in this study. One patient lost to follow-up, the remaining 21 were allocated to Ablation group and 21 were allocated to Traction group. The total therapeutic efficacy of all patients was 69.05% (61.90% in Ablation group and 76.19% in Traction group), but there was no statistical significance between the two groups (P= 0.317). The value of sleep scale score (ESS and QSQ), objective sleep variables (apnea-hypopnea index, oxygen saturation, percentage of time with blood oxygen less than 90% in total sleep time, oxygen desaturation index and micro-arousals) and upper airway cross-sectional area (palatopharyngeal and retrolingual area) of the two groups were improved (P<0.05), but the differences between the two groups were not statistically significant (P>0.05). Conclusion: For moderate to severe OSAHS who had glossopharyngeal plane obstruction, both HUPPP plus radiofrequency ablation of tongue base or HUPPP plus traction of tongue base are effective treatment for OSAHS, and the curative effect is similar. The choice of surgical type could be selected according to patient's or surgical conditions.
目的： 比较韩氏悬雍垂腭咽成形术（Han-uvulopalatopharyngoplasty，H-UPPP）联合舌根射频消融术或舌根牵引术治疗存在舌咽平面阻塞的中重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的疗效。 方法： 参照多中心临床随机对照试验方法，研究纳入2017年3月至2019年7月在上海3个临床中心就诊的不耐受持续正压通气（CPAP）治疗，且经上气道评估存在包括腭咽和舌咽平面阻塞的中重度OSAHS患者。按手术方式随机（简单随机）分成两组：HUPPP+舌根射频消融术（射频组）、HUPPP+舌根牵引术（牵引组）。所有入组患者完成了整夜多导睡眠监测（PSG）、上气道评估（Friedman分型、Müller试验、CT及头影测量）、术前常规检查，以及Epworth嗜睡量表（Epworth Sleepiness Scale，ESS）和魁北克睡眠问卷（Quebec sleep questionnaire，QSQ）。术后6~12个月复查，再次进行上述所有检查。手术前后各项指标的变化量以术后减去术前数值表示。采用SPSS 20.0统计软件进行统计学处理。 结果： 共有43例中重度OSAHS患者入组，射频组21例，牵引组22例（失访1例）。所有患者手术总有效率69.05%，其中射频组（61.90%）总有效率略低于牵引组（76.19%），但组间差异不具有统计学意义（χ2=1.003，P=0.317）。两种术式手术前后对患者的睡眠量表评分［ESS（射频组t=2.513，P=0.021；牵引组t=5.581，P<0.001），QSQ（射频组t=3.143，P =0.005；牵引组t=3.473，P =0.002）］，睡眠相关指标［呼吸暂停低通气指数（射频组t=4.970，P =0.00；牵引组t=8.760，P<0.001），最低血氧饱和度（射频组t=2.899，P =0.009；牵引组t=6.260，P<0.001），血氧饱和度低于90%累积时间（射频组 t=3.995，P =0.001；牵引组t=5.124，P<0.001），氧减指数（射频组t=5.357，P<0.001；牵引组t=8.355，P<0.001），微觉醒指数（射频组t=2.870，P=0.009；牵引组t=4.818，P<0.001）］，平静呼吸时上气道截面积［腭咽区（射频组t=5.162，P<0.001；牵引组t=3.716，P =0.001），舌后区（射频组t=4.379，P<0.001；牵引组t=3.998，P =0.001）］和深吸气时上气道截面积［腭咽区（射频组t=3.664，P=0.002；牵引组t=5.553，P<0.001）、舌后区（射频组t=2.725，P=0.013；牵引组t=4.020，P=0.001）］有改善作用，但两组之间的差异均不具有统计学意义（P值均>0.05）。 结论： 对于存在舌咽平面阻塞的中重度OSAHS患者，H-UPPP联合舌根射频消融术或舌根牵引手术疗效接近，均是有效的OSAHS治疗方法，可以根据患者情况及手术条件酌情选择。.