睡眠時呼吸障害患者の咽頭拡大術の適応と治療効果

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  • Pharyngeal Surgery for Sleep Related Breathing Disorders; Indications and Results.

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In this paper, the term “pharyngeal surgery” is used as an inclusive term for plasticsurgeries at the faucial level for sleep related breathing disorders (SRBD): uvulectomy, palatoplasty, UPPP, and etc. It does not include midline glossectomy, mandibular hyoidadvancement surgery, etc.<BR>The long term (6-24 months) and short term (14-28 days) effects of the pharyngealsurgery on SRBD were studied.<BR>The long term effect was studied by a questionnaire answered by 97 patients. Improvementof snoring was noted by 84.5%, and of apnea by 94.5%. The results of surgery wererated as satisfactory by 93.8%.<BR>The short term effect was studied by nocturnal polysomnography in 22 patients. Criteriawere established to define pharyngeal surgery responders as those who showed a 50% or morereduction in the apnea index and a postoperative index of less than 20. Improvement wasdocumented in 81.0%.<BR>The sites of obstruction were observed by nasendoscopic diurnal polysomnography undersedation with diazepam to be the soft palate, base of tongue or both. Pharyngeal surgerywas most effective in treating soft palate obstruction.<BR>The discrepancy in past reports of the effects of pharyngeal surgery seems to be due todifferences in the accuracy of diagnosis of the site of obstruction.<BR>In order to increase the effectiveness of pharyngeal surgery for SRBD, exact diagnosis ofthe site obstruction is important.

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