대한치과의사협회지 (The Journal of the Korean dental association)

  • 제52권10호
  • /
  • Pages.602-614
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  • 2014
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  • 0376-4672(pISSN)
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  • 2713-7961(eISSN)
대한치과의사협회 (The Korean Dental Association)
권호 표지

임상가를 위한 특집 2 - 폐쇄성 수면 무호흡증의 외과적 치료: 최신 경향

Surgical Management of Obsructive Slepp Apnea Syndrom: latest tendency

  • 송승일 (아주대학교병원 치과 구강악안면외과) ;
  • 이호경 (아주대학교병원 치과 구강악안면외과)
  • Song, Seung Il (Oral and Maxillofacial surgery, Department of Dentistry, Ajou University Hospital) ;
  • Lee, Ho Kyung (Oral and Maxillofacial surgery, Department of Dentistry, Ajou University Hospital)
  • 투고 : 2014.08.09
  • 심사 : 2014.09.29
  • 발행 : 2014.10.01
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⟨ 이전 논문 다음 논문 ⟩

초록

폐쇄성 수면 무호흡증(OSAS)환자의 외과적 치료(surgical treatment)로는 다양한 방법들이 있고 수술 방법의 선택시 여러 인자들을 고려해서 선택해야 한다. 즉, 수술은 폐쇄성 수면 무호흡증(OSAS)을 조절하는데 있어 보존적 치료 (non-surgical treatment)의 좋은 대체 방안(alternative chance)이 될 수 있기에, 증상(OSAS)의 주관적(subjective), 객관적(objective), 심각성(severity)을 해부학적 이상(anatomic abnormality) 정도와 연관시켜 적절한 수술법(surgical procedure)을 선택해야 한다. 수술 방법은 한가지 방법을 사용(single-level)하는지, 여러 수술 방법을 통합하여 사용(multi-level)하는지에 따라 다양하며, 그 예후도 각각 다르다. 중요한 점은 다단계 폐색(multilevel obstruction)이 있는 경우에는 다단계 치료(multilevel treatment) 방법이 가장 추천된다는 것이며, 이는 단지 증상(OSAS)의 심각성(severity)을 기준으로만 평가해서는 안되며 경도나 중등도(mild to moderate)의 환자에서도 필요시 보존적 치료(non-surgical treatment)를 시행하기 전에 다단계 외과적 치료(multilevel surgical treatment) 방법을 적극적으로 고려해야 한다. 비록 다단계 치료(multilevel treatment)방법은 상대적으로 짧은 임상 기간을 거쳤지만, 앞으로 지속적인 연구 결과(evidence-based data)를 이어간다면, 개개 환자에 맞는 최적의 치료 방법(optimal surgical intervention)을 제시할 수 있을 것이다.

Obstructive sleep apnea syndrom(OSAS) is defined by total or partial collapse of the upper airway during sleep. In the presence of specific anatomic features, OSAS is potentially amenable to surgical treatment. Initially, the only treatment available for these patients was a tracheotomy that bypassed the obstruction and resulted in a 100% cure. However, this was not readily accepted by most patients, and surgical methods other than tracheotomy were developed to successfully maintain adequate upper airway patency during sleep by comparing to postoperative polysomnography(AHI,RDI etc). In this paper, I would like to provide an overview of some of the multilevel surgical techniques available for treating OSAS as well as the necessary preoperative considerations.

키워드

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