Zusammenfassung
Erstbescheibungen der Uvulopalatopharyngoplastik (UPPP) erfolgten 1964 bzw. 1981 zur Therapie des Schnarchens bzw. der obstruktiven Schlafapnoe (OSA). Die ersten Op.-Techniken bei OSA waren sehr invasiv, was häufig mit erheblichen Komplikationen verbunden war. Wolfgang Pirsig et al. erkannten als Erste in Deutschland, dass eine radikale Op.-Technik nur die Komplikations-, nicht aber die Erfolgsrate der UPPP verbessert. Die aus dieser Erkenntnis abgeleitete schonendere Op.-Technik ist bis heute etabliert. Eine Metaanalyse von 1996 ergab eine Erfolgsquote der UPPP von gut 50 %. Hochwertige randomisierte Studien zeigen die hoch signifikante Überlegenheit der UPPP mit Tonsillektomie im Vergleich zu unbehandelten Kontrollen. Der Effekt der klassischen UPPP auf objektive Erfolgsparameter war jedoch durch gezieltere Patientenauswahl nicht wesentlich zu steigern und ließ mit der Zeit oft nach. Daher wurden Modifikationen der UPPP entwickelt. Diese lassen sich bei limitierter Datenlage nur schwer im Vergleich zur klassischen UPPP bewerten. In den Studien mit Vergleich einer Modifikation gegenüber der konventionellen UPPP zeigte sich eine Überlegenheit der jeweiligen Modifikation. Einschränkungen der Aussagekraft sind u. a. dadurch bedingt, dass die Publikationen jeweils vornehmlich von maximal 2 unterschiedlichen, unabhängigen Arbeitsgruppen stammen und die Nachsorgeintervalle meist nur bei 6 Monaten liegen. Auch zu Komplikationsraten ist die Datenlage noch zu dünn für tragfähige Aussagen. Zur klassischen UPPP gibt es wesentlich umfangreichere Daten, längere Erfahrungswerte und belastbarere Studien auch zu Therapieeffekten neben der Reduktion respiratorischer Ereignisse. Die Modifikationen der UPPP sollten derzeit vornehmlich in klinischen Studien eingesetzt werden.
Abstract
Uvulopalatopharyngoplasty (UPPP) was first described in 1964 with regard to surgical treatment of snoring and in 1981 with regard to treatment of obstructive sleep apnea (OSA). The initial surgical techniques for OSA were very invasive, frequently leading to significant morbidity and complications. Wolfgang Pirsig et al. were the first in Germany to recognize that a radical surgical technique increased only the complications, not the efficacy of UPPP. The less invasive surgical technique developed based on these findings is still established in Germany. A meta-analysis from 1996 described a success rate of UPPP of about 50%. High-quality randomized trials demonstrate significant superiority of UPPP plus tonsillectomy compared to untreated controls. However, the objective outcome measures of classic UPPP could not be improved even with additional patient selection criteria, and the effects of UPPP often deteriorate over time. To overcome these limitations, various modifications of UPPP have been developed. Due to limited data, evaluation of these new techniques and their comparison with conventional UPPP is difficult at present. In studies comparing a modification of UPPP with the standard approach, the tested modification was demonstrated to be superior. A relevant limitation of the available data results from the small number of institutions (usually not more than two) that investigated the respective modification and the follow-up periods of usually only 6 months. Data are also too sparse to reliably assess complication rates. For conventional UPPP there are considerably more data, wider experience with long-term outcome, and more robust studies examining treatment effects beyond basic respiratory parameters. At present, modifications of UPPP should be principally employed in clinical trials.
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T. Verse und B.A. Stuck geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
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Herrn Prof. Dr. med. Wolfgang Pirsig zum 80. Geburtstag gewidmet.
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Verse, T., Stuck, B.A. Moderne Modifikationen der Uvulopalatopharyngoplastik . HNO 65, 90–98 (2017). https://doi.org/10.1007/s00106-016-0300-1
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DOI: https://doi.org/10.1007/s00106-016-0300-1
Schlüsselwörter
- Weichgaumen
- Obstruktive Schlafapnoe
- Hals-Nasen-Ohren-ärztliche operative Therapieverfahren
- Uvula
- Komplikationen