Abstract:

Objective　To systematically evaluate the safety and efficacy of modified uvulopalatopharyngoplasty (H-UPPP) combined with tongue root radiofrequency ablation in the treatment of patients with moderate-to-severe obstructive sleep apnea hypopnea syndrome (OSAHS). Methods　The literatures related to randomized controlled trials on H-UPPP combined with tongue root radiofrequency ablation in the treatment of patients with moderate-to-severe OSAHS were searched from Pubmed, China Biomedical Abstracts Database (CBM), Embase, Wanfang Database, China Knowledge Network Database (CNKI), and Wipro Database (VIP) from their establishment to January 2024. The experimental group took H-UPPP and tongue root radiofrequency ablation, and the control group H-UPPP. The literature quality of the included randomized controlled trials was evaluated by the Cochrane Risk of Bias Assessment Tool. The data were analyzed using meta-analysis by the RevMan 5.4 software. Results　A total of 2 596 literatures were identified. According to the inclusion and exclusion criteria, 7 studies with 625 patients (321 cases in the experimental group and 304 cases in the control group) were finally included. The results of meta-analysis showed that the overall effective rate (OR=3.26, 95%CI 1.82-5.86, P<0.000 1), apnea-hyponea index (OR=-7.11, 95%CI -11.86--2.35, P=0.003), the lowest oxygen saturation (OR=6.62, 95%CI 1.89-11.35, P=0.006), and score of Epworth Sleepiness Scale (OR=-0.90, 95%CI -1.61--0.20, P=0.01) in the experimental group were better than those in the control group. The incidence rate of temporary complications in the experimental group was higher than that in the control group (OR=2.68, 95%CI 1.34-5.35, P=0.005). Conclusions　For patients with moderate-to-severe OSAHS, H-UPPP combined with tongue root radiofrequency ablation is more effective than H-UPPP alone, with a higher incidence rate of postoperative temporary complications and no statistical difference in long-term complications.

Key words:

Obstructive sleep apnea hypopnea syndrome, Modified uvulopalatopharyngoplasty, Tongue root radiofrequency ablation, Surgery,  , Meta-analysis

摘要：

目的　对改良悬雍垂腭咽成形术（H-UPPP）联合舌根射频消融术治疗中重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的安全性及有效性进行系统评估。方法　通过检索Pubmed、中国生物医学文摘数据库（CBM）、EmBase、万方数据库、中国知网数据库（CNKI）、维普数据库（VIP）有关于H-UPPP联合舌根射频消融术治疗中重度OSAHS的随机对照试验相关文献，检索时间为建库至2024年1月。试验组采用H-UPPP联合舌根射频消融术治疗，对照组采用单纯H-UPPP治疗。根据Cochrane偏倚风险评估工具对所纳入的随机对照试验进行文献质量评价。数据采用RevMan 5.4软件进行meta分析。结果　初检出文献2 596篇，根据纳入及排除标准，最终纳入7项研究，共计625例患者（试验组321例，对照组304例）。meta分析结果显示，H-UPPP联合舌根射频消融术治疗中重度OSAHS的总有效率（OR=3.26，95%CI 1.82～5.86，P<0.000 1）、呼吸暂停低通气指数（OR=-7.11，95%CI -11.86～-2.35，P=0.003）、最低血氧饱和度（OR=6.62，95%CI 1.89～11.35，P=0.006）及Epworth嗜睡量表评分（OR=-0.90，95%CI -1.61～-0.20，P=0.01）均优于单纯H-UPPP；而在并发症方面，试验组暂时性并发症发生率高于对照组（OR=2.68，95%CI 1.34～5.35，P=0.005）。结论　与单纯H-UPPP相比，H-UPPP联合舌根射频消融术治疗中重度OSAHS的效果较好，术后暂时并发症发生率高于单纯H-UPPP，远期并发症无明显差异。

关键词:

阻塞性睡眠呼吸暂停低通气综合征, 改良悬雍垂腭咽成形术, 舌根射频消融术, 外科手术, meta分析