扁桃体Ⅰ度阻塞性睡眠呼吸暂停低通气综合征患儿不同等离子术式远期疗效

doi:10.6040/j.issn.1673-3770.0.2017.126

摘要/Abstract

摘要： 目的探讨儿童扁桃体Ⅰ度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)低温等离子腺样体消融术与扁桃体+腺样体消融术远期疗效及影响因素。方法收集119例扁桃体Ⅰ度OSAHS患儿完整的临床资料,其中,实验组(60例)接受低温等离子扁桃体切除+腺样体消融术,对照组(59例)接受低温等离子腺样体消融术。通过术后6个月、1年、2年及4年的随访,比较两组患儿术后疗效及生活质量。结果术后4年,实验组治愈53例,好转4例,无效3例,总有效率95%;对照组治愈25例,好转24例,无效10例,总有效率83.05%。实验组患儿疗效明显优于对照组,差异具有统计学意义(P<0.1)。术后疗效的影响因素有年龄、肥胖、合并有鼻-鼻窦炎、中耳炎、合并牙颌面畸形等。实验组中远期并发症咽部异物感2例。结论低温等离子切除肥大的腺样体及扁桃体是治疗扁桃体Ⅰ度OSAHS患儿的有效方法。

关键词: 扁桃体, 腺样体, 儿童, 低温等离子, 睡眠呼吸暂停,阻塞性

Abstract: Objective To analyze the long-term efficacy and factors influencing clinical outcomes of adenoidectomy and tonsillectomy using ablation in pediatric patients with grade 1 tonsils and obstructive sleep apnea hypopnea syndrome(OSAHS). Methods Clinical data of 119 children with grade 1 tonsils and obstructive sleep apnea hypopnea syndrome(OSAHS)were collected. Children were treated using different surgeries between January and December 2012, and the surgical outcomes were retrospectively analyzed. Patients in the experimental group(60 cases)were treated with adenoidectomy and tonsillectomy with ablation; patients in the control group(59 cases)were treated with adenoidectomy ablation. Postoperative efficacy and quality of life of the two groups were compared after 6 months and 1, 2, and 4 years. Results Four years after surgery, in the experimental group, 53 patients were cured, 4 showed improvement, and 3 had experienced no effect; the total effective rate was 95%. In the control group, 25 patients were cured, 24 showed improvement, and 10 were invalid; the total effective rate was 83.05%. The effective rate of the experimental treatment was statistically superior to the effective rate of the control treatment(P<0.1). The factors influencing clinical outcomes included age, obesity, rhinitis and nasosinusitis, otitis media, and dento-maxillofacial deformities. The long-term complications included two cases of pharyngeal foreign body in the experimental group. Conclusion Adenoidectomy and tonsillectomy with ablation is an effective method for treatment of children with OSAHS with grade 1 tonsils.

Key words: Ablation, Tonsil, Adenoid, Sleep apnea hyponea syndrome, obstructive, Children

中图分类号:

R766.7

尹娟,何颖瑶,郭鹤龄,肖旭平. 扁桃体Ⅰ度阻塞性睡眠呼吸暂停低通气综合征患儿不同等离子术式远期疗效[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 87-90.

YIN Juan, HE Yingyao, GUO Heling, XIAO Xuping. Analysis of the long-term clinical effects of different plasma operations on obstructive sleep apnea hypopnea syndrome in children with grade 1 tonsils.[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2017, 31(3): 87-90.

参考文献

[1] 周成勇,孙宝春,王丰,等.低温等离子辅助下儿童腺样体和扁桃体手术临床疗效观察[ J].临床耳鼻咽喉头颈外科杂志,2016, 30(11):863-866. ZHOU Chengyong, SUN Baochun, WANG Feng, et al. Clinical effect analysis of adenoidectomy and tonsillectomy assisted with ablation on children[J]. Clin J Otorhinolarynol Head Neck Surg, 2016, 30(11):863-866.
[2] Temple RH, Timms MS. Paediatric coblation tonsillectomy[J]. Int J Pediatr Otorhinolaryngol, 2001, 61(3):195-198.
[3] 中华医学会呼吸病学分会睡眠呼吸障碍学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J]. 中华结核和呼吸杂志, 2012, 35(1):9-12.
[4] 何忠明,韩美荣,宋玉玲,等. 鼾症及其相关危险因素流行病调查 [J]. 新疆医学, 2011, 41(11):16-19. HE Zhongming, HAN Meirong, SONG Yuling, et al. Epidemlologic study and analysis of related factors of snoring[J]. Xinjiang Med J, 2011, 41(11):16-19.
[5] Lock C, Wilson J, Steen N, et al. North of england and scotland study of tonsillectomy and adenotonsillectomy in Children(NESSTAC): a pragmatic randomised controlled trial with a parallel nonrandomised preference study[J].Health Technol Assess, 2015, 14(13):1-164.
[6] 符涛,范小全. 手术治疗儿童鼾症与扁桃体腺样体肥大疗效观察[J]. 中华全科医学,2010,8(1):56-57. FU Tao, FAN Xiaoquan. Surgical treatment of children snoring symptom by excising hypertrophy tonsil and adenoids[J].Chin J Gen Prac, 2010, 8(1):56-57.
[7] 陈芳, 李晓艳. 扁桃体腺样体切除对儿童阻塞性睡眠呼吸暂停低通气综合征术后免疫功能的影响[J]. 临床耳鼻咽喉头颈外科杂志, 2012(7):333-336. CHEN Fang, LI Xiaoyan. Tonsillectomy and adenoidectomy in children with obstructive sleep apnea hypopnea syndrome postoperative immune function influence[J]. Clin J Otorhinolarynol Head Neck Surg, 2012(7):333-336.
[8] Belloso A, Chidambaram A, Morar P, et al. Coblation tonsillectomy versus dissection tonsillectomy:postoperative hemorrhage[J]. Laryngoscope, 2003, 113(11):2010-2013.
[9] 汪普, 李勇. 鼻内镜下低温等离子刀扁桃体部分切除术联合腺样体切除术治疗儿童OSAHS的疗效分析[J]. 中国中西医结合耳鼻咽喉科杂志, 2015, 23(4): 287-290. WANG Pu, LI Yong. Partial tonsillectomy by low temperature plasma ablation combined with adenoidectomy under nasal endoscope for children with OSAHS[J]. Chin J Otorhinolaryngol Integ Med, 2015, 23(4):287-290.
[10] 中华耳鼻咽喉头颈外科杂志编委会,中华医学会耳鼻咽喉科分会.儿童阻塞性睡眠呼吸暂停低通气综合征诊疗指南草案(乌鲁木齐)[J]. 中华耳鼻咽喉头颈外科杂志,2007, 42(2):83-84.
[11] 常英展, 缪东生, 罗伟, 等. 儿童阻塞性睡眠呼吸暂停低通气综合征治疗方法选择及疗效观察[J].中国耳鼻咽喉颅底外科杂志,2016(2):39-40. CHANG Yinzhang, MIU Dongsheng, LUO Wei, et al. Treatment options and curative effect of pediatric obstructive sleep apnea-hypopnea syndrome[J]. Chin J Otorhinolarngol Skull Base Surg, 2016(2):39-40.

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