腺样体扁桃体切除术治愈儿童阻塞性睡眠呼吸暂停综合征的偏误研究

doi:10.6040/j.issn.1673-3770.0.2019.127

摘要/Abstract

摘要：

阻塞性睡眠呼吸暂停综合征（OSAS）在我国儿童中的发病率分别为男童5.8%和女童3.8%，会影响儿童正常的生长发育，导致儿童生长迟滞、神经认知缺陷、智力发育及行为异常等问题，因此早期识别与诊断并进行适当的早期治疗至关重要。儿童OSAS的治疗方法多种多样，从内科的药物治疗到外科的手术治疗，从耳鼻咽喉的专科治疗到多学科联合治疗，治疗效果参差不齐，公认的一线治疗仍然是手术，而手术又以腺样体扁桃体联合切除术（AT）为主流。AT术后疗效及并发症众说纷纭，有学者认为AT治疗儿童OSAS疗效显著，症状可完全缓解；另有一部分学者则认为AT治疗儿童OSAS的疗效有待商榷，术后并发症及残余疾病很难避免，AT还不足以治愈OSAS患儿。对儿童OSAS的AT治疗进行阐述，以期为临床治疗儿童OSAS提供参考。

关键词: 阻塞性睡眠呼吸暂停综合征, 儿童, 腺样体扁桃体切除术, 治疗结局

Abstract:

The incidence of obstructive sleep apnea syndrome (OSAS) in Chinese children is 5.8 per cent in boys and 3.8 per cent in girls^{and is therefore, a common group of diseases in childhood. The occurrence and development of OSAS affects the normal growth and development of children, resulting in growth retardation, neurocognitive defects, abnormalities in intellectual development and behavior, and other problems. Therefore, early recognition, diagnosis, and initiation of appropriate treatment is crucial in OSAS. The treatment methods for OSAS in children varies, including; Conservative treatment with internal medicine, surgery, specialized otolaryngology treatment, and a multi-disciplinary combined treatment with varying therapeutic effects. However, surgery continues to be the recognized first-line treatment for pediatric OSAS with adenotonsillectomy (AT) being the mainstay treatment. However, there are differing opinions on the efficacy and postoperative complications of AT. Some scholars believe that AT results in significant improvements and that the symptoms of OSAS can be completely relieved after this procedure. Other scholars believe that the efficacy of AT is still questionable and that postoperative complications and residual disease are difficult to avoid, and therefore, AT is not enough to cure OSAS in children. After reviewing the literature exhaustively, this paper elucidates AT treatment of OSAS in children, to provide a reference for the clinical treatment of this syndrome.}

Key words: Obstructive sleep apnea syndrom, Child, Adenotonsillectomy, Treatment outcome

中图分类号:

R766

吴兆坤,朱新华. 腺样体扁桃体切除术治愈儿童阻塞性睡眠呼吸暂停综合征的偏误研究[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 148-152.

Zhaokun WU,Xinhua ZHU. Can adenotonsillectomy adequately cure children with obstructive sleep apnea syndrome[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 148-152.

参考文献 36

1	Li AM , So HK , Au CT , et al . Epidemiology of obstructive sleep apnoea syndrome in Chinese children: a two-phase community study[J]. Thorax, 2010, 65(11): 991-997. doi:10.1136/thx.2010.134858 . doi: 10.1136/thx.2010.134858
2	韦岑, 袁伟 . 儿童阻塞性睡眠呼吸障碍的诊治研究进展[J]. 广西医学, 2017, 39(7): 1073-1076. Doi: 10.11675/j.issn.0253-4304.2017.07.40 . doi: 10.11675/j.issn.0253-4304.2017.07.40
3	Liu X , Immanuel S , Kennedy D , et al . Effect of adenotonsillectomy for childhood obstructive sleep apnea on nocturnal heart rate patterns[J]. Sleep, 2018, 41(11). doi:10.1093/sleep/zsy171 . doi: 10.1093/sleep/zsy171
4	Liu X , Immanuel S , Pamula Y , et al . Adenotonsillectomy for childhood obstructive sleep apnoea reduces thoraco-abdominal asynchrony but spontaneous apnoea-hypopnoea index normalisation does not[J]. Eur Respir J, 2017, 49(1): 1601177. doi:10.1183/13993003.01177-2016 . doi: 10.1183/13993003.01177-2016
5	Bhattacharyya N , Lin HW . Changes and consistencies in the epidemiology of pediatric adenotonsillar surgery, 1996-2006[J]. Otolaryngol Head Neck Surg, 2010, 143(5): 680-684. doi:10.1016/j.otohns.2010.06.918 . doi: 10.1016/j.otohns.2010.06.918
6	Song SA , Tolisano AM , Cable BB , et al . Neurocognitive outcomes after pediatric adenotonsillectomy for obstructive sleep apnea: A systematic review and meta-analysis[J]. Int J Pediatr Otorhinolaryngol, 2016, 83: 205-210. doi:10.1016/j.ijporl.2016.02.011 . doi: 10.1016/j.ijporl.2016.02.011
7	Lee CH , Hsu WC , Chang WH , et al . Polysomnographic findings after adenotonsillectomy for obstructive sleep apnea in obese and non-obese children: a systemic review and meta-analysis[J]. Clinical otolaryngology, 2016, 41(5): 498-510. doi: 10.1111/coa.12549 . doi: 10.1111/coa.12549
8	Borgström A , Nerfeldt P , Friberg D . Adenotonsillotomy versus adenotonsillectomy in pediatric obstructive sleep apnea: an RCT[J]. Pediatrics, 2017, 139(4): e2016-3314. doi:10.1542/peds.2016-3314 . doi: 10.1542/peds.2016-3314
9	Kaditis AG , Alonso Alvarez ML , Boudewyns A , et al . Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management[J]. Eur Respir J, 2016, 47(1): 69-94. doi:10.1183/13993003.00385-2015 . doi: 10.1183/13993003.00385-2015
10	Giordano L , Toma S , Palonta F , et al . Obstructive sleep apnea in Prader-Willi syndrome: risks and advantages of adenotonsillectomy[J]. Pediatr Med Chir, 2015, 37(2): doi: 10.4081/pmc.2015. 107
	pmc .2015.107. doi:10.4081/pmc.2015. 107 . doi: 10.4081/pmc.2015. 107
11	Marcus CL , Moore RH , Rosen CL , et al . A randomized trial of adenotonsillectomy for childhood sleep apnea[J]. N Engl J Med, 2013, 368(25): 2366-2376. doi:10.1056/nejmoa1215881 . doi: 10.1056/nejmoa1215881
12	Imanguli M , Ulualp SO . Risk factors for residual obstructive sleep apnea after adenotonsillectomy in children[J]. Laryngoscope, 2016, 126(11): 2624-2629. doi:10.1002/lary.25979 . doi: 10.1002/lary.25979
13	Koren D , Gozal D , Bhattacharjee R , et al . Impact of adenotonsillectomy on insulin resistance and lipoprotein profile in nonobese and obese children[J]. Chest, 2016, 149(4): 999-1010. doi:10.1378/chest.15-1543 . doi: 10.1378/chest.15-1543
14	Amin R , Holler T , Narang I , et al . Adenotonsillectomy for obstructive sleep apnea in children with complex chronic conditions[J]. Otolaryngol Head Neck Surg, 2018, 158(4): 760-766. doi:10.1177/0194599817746 doi: 10.1177/0194599817746
15	Boudewyns A , Abel F , Alexopoulos E , et al . Adenotonsillectomy to treat obstructive sleep apnea: Is it enough?[J]. Pediatr Pulmonol, 2017, 52(5): 699-709. doi:10.1002/ppul.23641 . doi: 10.1002/ppul.23641
16	Lennon CJ , Wang RY , Wallace A , et al . Risk of failure of adenotonsillectomy for obstructive sleep apnea in obese pediatric patients[J]. Int J Pediatr Otorhinolaryngol, 2017, 92: 7-10. doi:10.1016/j.ijporl.2016.09.026 . doi: 10.1016/j.ijporl.2016.09.026
17	De A , Waltuch T , Gonik NJ , et al . Sleep and breathing the first night after adenotonsillectomy in obese children with obstructive sleep apnea[J]. J Clin Sleep Med, 2017, 13(6): 805-811. doi:10.5664/jcsm.6620 . doi: 10.5664/jcsm.6620
18	许志飞, 倪鑫 . 重视阻塞性睡眠呼吸暂停低通气综合征儿童腺样体扁桃体切除术后的管理[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 9-13. doi:10.6040/j.issn.1673-3770.0.2018.069 . doi: 10.6040/j.issn.1673-3770.0.2018.069
	XU Zhifei , NI Xin . Post-surgery management in children with obstructive sleep apnea syndrome[J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(2): 9-13. doi:10.6040/j.issn.1673-3770.0.2018.069 . doi: 10.6040/j.issn.1673-3770.0.2018.069
19	Fehrm J , Nerfeldt P , Sundman J , et al . Adenopharyngoplasty vs adenotonsillectomy in children with severe obstructive sleep apnea: A randomized clinical trial[J]. JAMA Otolaryngol Head Neck Surg, 2018, 144(7): 580-586. doi:10.1001/jamaoto.2018.0487 . doi: 10.1001/jamaoto.2018.0487
20	El-Kersh K , Cavallazzi R , Senthilvel E . Outcomes of adenotonsillectomy in severe pediatric obstructive sleep apnea[J]. Ear Nose Throat J, 2017, 96(12): E6-E9. doi:10.1177/014556131709601202 . doi: 10.1177/014556131709601202
21	Lee DJ , Chung YJ , Yang YJ , et al . The impact of allergic rhinitis on symptom improvement in pediatric patients after adenotonsillectomy[J]. Clin Exp Otorhinolaryngol, 2018, 11(1): 52-57. doi:10.21053/ceo.2017.00500 . doi: 10.21053/ceo.2017.00500
22	Maris M , Verhulst S , Wojciechowski M , et al . Outcome of adenotonsillectomy in children with Down syndrome and obstructive sleep apnoea[J]. Arch Dis Child, 2017, 102(4): 331-336. doi:10.1136/archdischild-2015-310351 . doi: 10.1136/archdischild-2015-310351
23	Farhood Z , Isley JW , Ong AA , et al . Adenotonsillectomy outcomes in patients with Down syndrome and obstructive sleep apnea[J]. Laryngoscope, 2017, 127(6): 1465-1470. doi:10.1002/lary.26398 . doi: 10.1002/lary.26398
24	Harris N , Rosenberg A , Jangda S , et al . Prevalence of obesity in international special Olympic athletes as determined by body mass index[J]. J Am Diet Assoc, 2003, 103(2): 235-237. doi:10.1053/jada.2003.50025 . doi: 10.1053/jada.2003.50025
25	Alsufyani N , Isaac A , Witmans M , et al . Predictors of failure of DISE-directed adenotonsillectomy in children with sleep disordered breathing[J]. Journal of Otolaryngology - Head & Neck Surgery, 2017, 46(1): 37. doi: 10.1186/s40463-017-0213-3 . doi: 10.1186/s40463-017-0213-3
26	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. doi:10.3760/j.issn:1673-0860.2007.02.002 . doi: 10.3760/j.issn:1673-0860.2007.02.002
	Editorial Board Of Chinese Journal Of Otorhinolary, Chinese Otorhinolaryngology Of Chinese Medical Ass . Draft of guidelines for the diagnosis and treatment of pediatric sleep apnea hypopnea syndrome (Urumqi)[J]. Chin J Otorhinolaryngol Head Neck Surg, 2007, 42(2): 83-84. doi:10.3760/j.issn:1673-0860.2007.02.002 . doi: 10.3760/j.issn:1673-0860.2007.02.002
27	Thomas NH , Xanthopoulos MS , Kim JY , et al . Effects of adenotonsillectomy on parent-reported behavior in children with obstructive sleep apnea[J]. Sleep, 2017, 40(4). doi:10.1093/sleep/zsx018 . doi: 10.1093/sleep/zsx018
28	Ye J , Liu H , Zhang GH , et al . Outcome of adenotonsillectomy for obstructive sleep apnea syndrome in children[J]. Ann Otol Rhinol Laryngol, 2010, 119(8): 506-513. doi:10.1177/000348941011900802 . doi: 10.1177/000348941011900802
29	Görgülü FF , Koç AS , Görgülü O . Pneumomediastinum, pneumopericardium, and epidural pneumatosis following adenotonsillectomy: A very rare complication[J]. Case Rep Otolaryngol, 2018, 2018: 4531364. doi:10.1155/2018/4531364 . doi: 10.1155/2018/4531364
30	de Luca Canto G , Pacheco-Pereira C , Aydinoz S , et al . Adenotonsillectomy complications: A meta-analysis[J]. Pediatrics, 2015, 136(4): 702-718. doi:10.1542/peds. 2015-1283 . doi: 10.1542/peds. 2015-1283
31	Ahmed E , Almutairi NK . Pulmonary edema post-adenotonsillectomy in children[J]. Saudi Medical Journal, 2018, 39(6):551-557. doi: 10.15537/smj.2018.6.21887 . doi: 10.15537/smj.2018.6.21887
32	Harounian JA , Schaefer E , Schubart J , et al . Pediatric adenotonsillectomy and postoperative hemorrhage: Demographic and geographic variation in the US[J]. Int J Pediatr Otorhinolaryngol, 2016,87:50-54. doi:10.1016/j.ijporl.2016.05.018 . doi: 10.1016/j.ijporl.2016.05.018
33	Konstantinopoulou S , Gallagher P , Elden L , et al . Complications of adenotonsillectomy for obstructive sleep apnea in school-aged children[J]. Int J Pediatr Otorhinolaryngol, 2015, 79(2): 240-245. doi:10.1016/j.ijporl. 2014.12.018 . doi: 10.1016/j.ijporl. 2014.12.018
34	Brown KA , Brouillette RT . The elephant in the room: lethal apnea at home after adenotonsillectomy[J]. Anesth Analg, 2014, 118(6): 1157-1159. doi:10.1213/ANE.0b013e31829ec1e6 . doi: 10.1213/ANE.0b013e31829ec1e6
35	Rahmanian R , Wan Fook Cheung V , Chadha NK . Non-fatal extensive cerebral venous thrombosis as a complication of adenotonsillectomy[J]. Int J Pediatr Otorhinolaryngol, 2015, 79(2): 254-258. doi:10.1016/j.ijporl. 2014.11.016 . doi: 10.1016/j.ijporl. 2014.11.016
36	Yildirim YS , Senturk E , Ozturan O . Posterior plica perforation: rare complication of adenotonsillectomy[J]. J Craniofac Surg, 2014, 25(4): e368-e369. doi:10.1097/SCS.0000000000000842 . doi: 10.1097/SCS.0000000000000842

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed

[1]	梁程程,王欣,雷大鹏. 电子鼻咽喉镜诊治27400例临床分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 107-110.
[2]	陈蔚华,张凯扬,郑晓彬. 小儿喉、气管、支气管异物221例临床分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 111-115.
[3]	刘鸣. 早期声门癌的内镜治疗[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 6-9.
[4]	申宇鹏,宋琦,李晓明. 喉癌前病变的病因、分子机制和处理策略[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 25-30.
[5]	钟晓声,杨海弟,郑亿庆. 突发性聋伴耳鸣的治疗与转归[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 43-46.
[6]	倪菁,雷飞,白丹,周韵,马建梅,黄伟,王春阳. 儿童分泌性中耳炎耳积液中免疫相关指标表达分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 56-59.
[7]	张贵阳,黄河,冼志,张汉文,谢桂彩. 粉尘螨滴剂舌下含服免疫治疗对不同年龄段变应性鼻炎患者的临床效果评估[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 60-65.
[8]	罗通勇,杨华清,岳胜清,贾全凡,袁龙. 帕尼单抗和紫杉醇一线治疗复发或转移性头颈肿瘤Ⅱ期患者效果观察[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 71-75.
[9]	赵海涛,石磊,王俊霞,王亚芳. 儿童危重气管支气管异物的气道管理及麻醉体会[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 96-98.
[10]	宋凡,黄炜峻,许华俊,关建,易红良. 阻塞性睡眠呼吸暂停综合征患者颈动脉弹性与氧化应激反应的关系[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 99-104.
[11]	季迪, 陈祥, 余林. 软腭平面手术联合舌骨悬吊术治疗阻塞性睡眠呼吸暂停综合征效果的Meta分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 124-130.
[12]	刘燕,魏萍,寇巍,胡思洁,武小芳,刘萌雅,陈成,姚红兵. 儿童腺样体肥大与耳鼻咽喉科常见疾病关系的研究进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 149-154.
[13]	闫志刚,张慧慧,于丹,刘岩,文连姬,王迪. 成人阻塞性睡眠呼吸暂停综合征患者认知功能障碍的诊断及治疗研究进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 155-161.
[14]	郎永耀,杨云,刘晴,徐林弟,林子萍. 咽喉反流性疾病的影响因素及治疗效果分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 119-123.
[15]	殷敏,程雷. 鼾症命名之我见[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 19-22.