山东大学耳鼻喉眼学报 ›› 2016, Vol. 30 ›› Issue (5): 42-48.doi: 10.6040/j.issn.1673-3770.0.2016.086

• 睡眠呼吸障碍性疾病 • 上一篇    下一篇

建立扁桃体腺样体不同手术方式对儿童阻塞性睡眠呼吸暂停低通气综合征疗效的系统评价体系

于青青,唐隽,王跃建   

  1. 佛山市第一人民医院耳鼻咽喉头颈外科, 广东 佛山 528000
  • 收稿日期:2016-03-04 出版日期:2016-10-20 发布日期:2016-10-20
  • 通讯作者: 王跃建. E-mail:fssywyj1881@sina.com E-mail:tommyair123@163.co
  • 作者简介:于青青. E-mail:tommyair123@163.co

A systemic review system to evaluate the effects of different tonsil and adenoid surgical methods on children with obstructive sleep apnea-hypopnea syndrome.

YU Qingqing, TANG Jun, WANG Yuejian   

  1. Department of Otolaryngology &Head and Neck Surgery, Foshan First People's Hospital, Foshan 528000, Guangdong, China
  • Received:2016-03-04 Online:2016-10-20 Published:2016-10-20

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摘要： 目的 探讨建立比较分析不同的扁桃体腺样体手术方式对儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)疗效的系统评价体系。 方法 计算机检索中国知网、万方数据库、中国生物医学文献数据库和维普数据库中关于扁桃体腺样体不同手术方式治疗儿童OSAHS的随机对照试验,时限为从建库到2016年7月。对纳入研究的质量进行严格评价与提取资料,对符合标准的文献进行系统评价,统计学处理分析应用RevMan 5.0软件。 结果 共纳入7篇随机对照试验。结果显示观察组与对照组的治愈率、有效率、术后低通气指数(AHI)及最低血氧饱和度(LSaO2)的比较,其差异均无统计学意义(P>0.05);而观察组的手术时间及术中出血量均少于对照组,两者间差异均有统计学意义(P<0.05)。只有1篇对比了腺样体切除伴扁桃体部分及全切术术前及术后6个月时体液免疫及细胞免疫指标的改变,无法进行Meta分析,故未能提供循证医学证据。 结论 目前不同术式对患儿免疫功能的影响及治疗效果的研究较少,而且术后观察时间不一致,但这些可查询到的研究均表明腺样体切除伴部分扁桃体切除术不会对儿童的体液及细胞免疫功能造成不良影响。8岁以下且扁桃体仅单纯增生肥大的OSAHS患儿,部分扁桃体切除+腺样体切除术既可改善通气障碍,又能保留扁桃体的免疫功能及减少手术时间和术中出血量,是治疗该类患者的理想方法。

关键词: 阻塞性睡眠呼吸暂停低通气综合征, 扁桃体, 系统评价, 儿童, 腺样体

Abstract: Objective To establish a systematic review system to compare the therapeutic effects of different tonsil and adenoid surgical procedures on childrens obstructive sleep apnea-hypopnea syndrome(OSAHS). Methods CNKI, Wanfang Data, CBM and VIP were searched for randomized controlled trials on the therapeutic effects of different tonsil and adenoid surgical procedures on childrens OSAHS from the date of establishment of the databases to July of 2016. The extracted data were analyzed by Revman 5.0. Results A total 7 studies were included. Meta-analysis showed the differences between the case group and control group in curative ratio, effective rate, AHI and LSaO2 werent significant(P>0.05), but the differences in the operation time and intraoperative blood loss were significant(P<0.05). Only one paper compared humoral and cellular immunity index before and 6 months after partial and total tonsillectomy with adenoidectomy, which could not be included in the meta-analysis. Conclusion Few researches on the effects of different surgical procedures on childrens immunity have been found, and control tests could not be carried out because of different observing time after surgery. The results from the present study indicate that partial tonsillectomy plus adenoidectomy does not impact on the humoral and cellular immunity of children. It is an ideal method for patients below eight with simple hypertrophy of tonsil and adenoid, which can not only improve ventilation disorder, but also retain the tonsil immune function and reduce the operation time and intraoperative blood loss.

Key words: Tonsil, Adenoid, Systematic review, Obstructive sleep apnea hypopnea syndrome, Children

中图分类号: 

  • R766.7
[1] 刘大波, 仇书要, 钟建文, 等. 儿童阻塞性睡眠呼吸暂停低通气综合征伴难治性癫痫的治疗[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44(5): 425-426. LIU Dabo, QIU Shuyao, ZHONG Jianwen, et al. Treatment of Obstructive Sleep Apnea-hypopnea with Refractory Epilepsy in Children[J]. Chin J Otorhinolarynol Head Neck Surg, 2009, 44(5): 425-426.
[2] Bandla P, Brooks L J, Trimarchi T, et al. Obstructive sleep apnea syndrome in children[J]. Anesthesiol Clin North America, 2005, 23(3): 535-549.
[3] 高雪梅, 杨凯, 曾祥龙. 儿童呼吸方式与颌面生长发育的关系[J]. 中华医学杂志, 2005, 85(44): 3105-3106. GAO Xuemei, YANG Kai, ZENG Xianglong. Relationship between respiratory pattern and craniofacial growth and development in children[J]. National Med J Chin, 2005, 85(44): 3105-3106.
[4] 中华医学会耳鼻咽喉科学分会, 中华耳鼻咽喉科杂志编委会. 阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准暨悬雍垂腭咽成形术适应证(杭州)[J]. 中华耳鼻咽喉科杂志, 2002, 37(6): 403-404.
[5] 殷明德. 小儿扁桃体和腺样体切除术适应证的免疫学基础[J]. 临床耳鼻咽喉头颈外科杂志, 2010, 24(9): 385-391. YIN Mingde. Immunological basis on indications of tonsillectomy and adenoidectomy for children[J]. Clin J Otorhinolarynol Head Neck Surg, 2010, 24(9): 385-391.
[6] 黄琦, 吴皓, 曹荣萍. 儿童阻塞性睡眠呼吸暂停综合征104例临床分析[J]. 临床儿科杂志, 2003, 21(9): 539-540. HUANG Qi, WU Hao, CAO Rongping. Clinical analysis of 104 children with obstructive sleep apnea syndrome[J]. J Clin Pediatrics, 2003, 21(9): 539-540.
[7] 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学分会. 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.
[8] Jadad A R, Moore R A, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?[J]. Control Clin Trials, 1996, 17(1): 1-12.
[9] 王朴, 郭毅, 张君梅, 等. 运动想象疗法对脑卒中后患者上肢运动功能康复效果的系统评价[J]. 中国循证医学杂志, 2011, 11(5): 529-539. WANG Pu, GUO Yi, ZHANG Junmei, et al. Efficacy of mental practice on rehabilitation of hand function in patients with post-stroke: a systematic review[J]. Chin J Evidence-based Med, 2011, 11(5): 529-539.
[10] 史艳春. 保留一侧扁桃体治疗OSAHS患儿的临床观察[J]. 中外健康文摘, 2012, 9(26): 249-250. SHI Yanchun. Clinical observation of one side tonsil retention for children with OSAHS[J]. World Health Digest, 2012, 9(26): 249-250.
[11] 韦善文, 孟立新, 谭柳春, 等. 扁桃体部分切除术治疗儿童阻塞性睡眠呼吸暂停综合征的临床分析[J]. 广西医科大学学报, 2014, 31(4): 695-696. WEI Shanwen, MENG Lixin, TAN Liuchun, et al. Clinical analysis of partial tonsillectomy for children with OSAHS[J]. J Guangxi Med Univ, 2014, 31(4): 695-696.
[12] 章旻, 阮冠鑫, 黄凯, 等. 扁桃体射频部分消融术治疗儿童阻塞性睡眠呼吸暂停低通气综合征的疗效分析[J]. 贵州医药, 2014, 38(10): 903-904. ZHANG Wen, RUAN Guanxin, HUANG Kai, et al. Analysis of tonsil radiofrequency ablation for children with OSAHS[J]. Guizhou Med J, 2014, 38(10): 903-904.
[13] 陈曦, 李进让. 部分或整体扁桃体等离子射频切除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征疗效对比[J]. 山东大学耳鼻喉眼学报, 2013, 27(3): 1-3. CHEN Xi, LI Jinrang. Partial radiofrequency ablation tonsillectomy for children with OSAHS[J]. J Otolaryngol Ophthalmol Shandong Univ, 2013, 27(3): 1-3.
[14] 汪志伟, 杨海弟, 鲁爱武, 等. 低温等离子刀辅助内镜下治疗大龄儿童阻塞性睡眠呼吸暂停低通气综合征的临床效果分析[J]. 中国医药指南, 2013, 11(23): 411-412. WANG Zhiwei, YANG Haidi, LU Aiwu, et al. Coblation treatment of temperature-controlled radiofrequency-assisted endoscopic in elder children with obstructive sleep apnea-hypopnea syndrome[J]. Guide Chin Med, 2013, 11(23): 411-412.
[15] 黎高新, 肖旭平, 凌科技. 儿童阻塞性睡眠呼吸暂停的手术方式及疗效分析[J]. 医学临床研究, 2009, 26(1): 69-70. LI Gaoxin, XIAO Xuping, LING Keji. Approach and efficacy of surgery for obstructive sleep apnea in children[J]. J Clin Research, 2009, 26(1): 69-70.
[16] 陈林, 张书嘉, 徐恒光. 一侧扁桃体加腺样体切除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征的疗效观察[J]. 中国医药导报, 2008, 5(20): 58-59. CHEN Lin, ZHANG Shujia, XU Hengguang. Effect of only one tonsillectomy and adenoidectomy in the children with obstructive sleep apnea hypopnea syndrome[J]. Chin Med Herald, 2008, 5(20): 58-59.
[17] 邹娟娟, 王岩, 李延忠. 不同术式对OSAHS患儿免疫功能的影响[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(5): 396-398. ZHOU Juanjuan, WANG Yan, LI Yanzhong. Effects of different surgical procedures on immunity of children with obstructive sleep apnea hypopnea syndrome[J]. Clin J Otorhinolarynol Head Neck Surg, 2016, 30(5): 396-398.
[18] 滕以书, 李兰, 梁振江, 等. 婴儿腺样体切除术临床诊治分析[J]. 中华耳鼻咽喉头颈外科杂志, 2012, 47(2): 150-151. TENG Yishu, LI Lan, LIANG Zhenjiang, et al. Clinical analysis of the diagnosis and treatment of adenoidectomy in infant[J]. Chin J Otorhinolarynol Head Neck Surg, 2012, 47(2): 150-151.
[19] 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, 2007, 13(1): 38-40. CHANG Yingzhan, LIAO Dongsheng, LUO Wei, et al. Treatment options and curative effect of pediatric obstructive sleep apnea-hypopnea syndrome[J]. Chin J Otorhinolaryngol Skull Base Surgery, 2007, 13(1): 38-40.
[20] Bitar M A, Dowli A, Mourad M. The effect of tonsillectomy on the immune system, a systemic review and meta-analysis[J]. Int J Pediatr Otorhinolaryngol, 2015, 79(26): 1184-1191.
[21] 周成勇, 代志瑶. 腺样体切除加扁桃体单纯消融或扁桃体部分切除加消融对OSAHS患儿术后免疫功能的影响[J]. 临床耳鼻咽喉头颈外科杂志,2011, 25(21):990-992. ZHOU Chengyong, DAI Zhiyao. Postoperative changes of immunity in children undergoing adenoidectomy with tonsil ablation or with partial tonsillectomy[J]. Clin J Otorhinolarynol Head Neck Surg, 2011, 25(21): 990-992.
[22] Dai Z Y, Huang D Y, Zhou C Y. Effects of partial tonsillectomy on the immune functions of children with obstructive sleep apnea-hypopnea syndrome at early stage[J]. Genet Mol Res, 2014, 13(2): 3895-3902.
[23] 关瑞, 贾文波, 张书嘉, 等. 儿童扁桃体肥大切除范围与临床效果分析研究[J]. 齐齐哈尔医学院学报, 2013, 34(19): 2832-2834. GUAN Rui, JIA Wenbo, ZHANG Shujia, et al. Study of the clinical effect and extent of tonsillectomy for enfant with tonsil hypertrophy[J]. J Qiqihar Univ Med, 2013, 34(19): 2832-2834.
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