局所麻酔下口蓋垂口蓋形成術の検討 [in Japanese] Modification of uvulopalatoplasty for snoring and obstructive sleep apnea [in Japanese]
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無呼吸を伴わない鼾症や睡眠時無呼吸症候群の患者にに対する局所麻酔下口蓋垂口蓋形成術の機器の選択, 手術手技の改良, および手術成績について検討した.同一患者の術後の疼痛・嚥下痛をVisual Analogue Scaleにより比較したところ (n=10), 半導体レーザーと超音波切開凝固装置との間に有意差は見いだせなかった (p=0 .36).術後6ヵ月の遊離端を縫合しないconventional-LAUP群 (n=15) での瘢痕拘縮化をきたした率は66.7%, 一方縫合したmodified-LAUP (n=15) 群の瘢痕拘縮化率は26.7%でった.Modified-LAUP手術手術成績は, 無呼吸を伴わない鼾症 (n=10) には8割, UARS (n=3) は全例, OSAS (n=10) には6割の有効率を示した.
Laser-assisted uvulopalatoplasty (LAUP) was modified to avoid postoperative complications. Two major complications of this surgery are temporary postoperative pain and medial curtain-like traction of the posterior pillar caused by the adhesion and scaring of the soft palate and uvula. Incisions were made on one side of the soft palate and the uvula with a diode laser and on the other side with an ultrasonically activated surgical system in the same patient (n=10). There was no significant difference between the results of the two surgical systems (p=0.36). After the conventional LAUP procedure, we sutured the edge of the soft palate and the uvula with 10 of 3-0 vicryl (modified LAUP). The rate of postoperative adhesions for the modified LAUP was 26.7% (n=15) and that of conventional LAUP was 66.7% (n=15). Twenty-three patients had Polysomnography (Alice 3<SUP>®</SUP>: Healthdyne Technologies, Marietta GA, USA) with recording of the esophageal pressure preoperatively and postoperatively. The efficacy of modified LAUP was elucidated. Among 10 non apneic snoring patients, in 8 snoring nearly disappeared or was reduced to an occasional soft snore (>50% Snoring index and snoring loudness reduction). In 2 patients, snoring persisted. All (n=3) upper airway resistance syndrome patients showed significant improvement (>50% arousal index and esophageal pressure reduction). Among 10 mild and moderate obstructive sleep apnea patients, 6 were responders (>50% AHI and esophageal pressure reduction) and 4 were non responders. These results demonstrated that our modification of the LAUP procedure is an effective surgical technique.
Stomato-pharyngology 13(3), 327-332, 2001-06-01
Japan Society of Stomato-pharyngology