低温等离子辅助下儿童扁桃体全切除与部分切除的比较

doi:10.6040/j.issn.1673-3770.1.2020.087

摘要/Abstract

摘要： 目的探讨应用低温等离子辅助下治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)时扁桃体全切除与部分切除的疗效比较。方法回顾性分析应用等离子技术手术治疗的4 311例儿童OSAHS患者病历资料。根据术式分为两组:A组358例,行低温等离子辅助下扁桃体全切除和腺样体切除术;B组3 953例,行低温等离子辅助下扁桃体切部分除和腺样体切除术,对比两组手术时间、术后疼痛程度、恢复正常进食的天数、术后继发性出血的发生率;随访1年,对比两组患者术前、术后睡眠打鼾及憋气症状评分以及复发率。结果 B组手术时间(28.42±9.51)min、术后疼痛程度(2.67±0.75)分、恢复正常进食的天数(7.15±2.56)d、术后继发性出血的发生率(0.15%)均低于A组,差异有统计学意义(t=9.841,P<0.01;t=30.251,P<0.01;t=31.489,P<0.01; χ2=13.224,P<0.01)。两组患者术前、术后睡眠打鼾评分差异有统计学意义(A组χ2=570.251,P<0.01;B组χ2=6 767.566,P<0.001);憋气评分差异有统计学意义(A组χ2=622.465,P<0.01;B组χ2=6 293.219,P<0.001);两组患者组间比较,打鼾及憋气评分差异均无统计学意义(F=4.643,P=0.075;F=5.335,P=0.06)。两组患者复发率差异无统计学意义(χ2=0.009,P=0.925)。结论应用低温等离子治疗儿童OSAHS,行扁桃体部分切除术的疗效和全切相当,但并发症明显少于扁桃体全切除术。

关键词: 儿童, 低温等离子, 扁桃体部分切除术, 扁桃体切除术, 腺样体切除术, 睡眠打鼾, 睡眠憋气

Abstract: Objective To compare the efficacy of coblation assisted tonsillectomy and tonsillotomy in the treatment of children with obstructive sleep apnea-hypopnea syndrome. Methods This was a retrospective review of 4 311 children who underwent adenoidectomy and coblation assisted tonsillectomy or tonsillotomy in our hospital from January 2004 to December 2018. The patients were divided into two groups according to the operation method performed along with adenoidectomy: coblation assisted tonsillectomy was performed in 358 patients in group A, and coblation assisted tonsillotomy was performed in 3953 patients in group B. The operation time, degree of postoperative pain, number of days taken to return to normal eating, and incidence of secondary hemorrhage were compared. After 1 year follow-up, the recurrence rate and sleep snoring and suffocation scores were compared between the two groups. Results The operation time(28.42±9.51 minutes), degree of postoperative pain(2.67±0.75), number of days taken to return to normal eating(7.15±2.56 days), and incidence of secondary hemorrhage(0.15%)in group B were lower than those in group A, and the differences were statistically significant(t=9.841, P<0.01; t=30.251, P<0.01; t=31.489, P<0.01; χ2=13.224, P<0.01). There was a significant difference in sleep snoring scores before and after the operation in both the groups(group A: χ2=570.251, P<0.01; group B: χ2=6 767.566, P<0.001). There was also a significant difference in the suffocation scores before and after the operation in both the groups(group A: χ2=622.465, P<0.01; group B: χ2=6 293.219, P<0.001), but there were no significant differences in sleep snoring and suffocation scores between the two groups(F=4.643, P=0.075; F=5.335, P=0.060). Additionally, there was no significant difference in recurrence rate between the two groups(χ2=0.009, P=0.925). Conclusion The curative effect of tonsillotomy is similar to that of tonsillectomy, but it can shorten the operation time, improve the patient's postoperative comfort and reduce the incidence of secondary bleeding.

Key words: Child, Coblation, Tonsillotomy, Tonsillectomy, Adenoidectomy, Sleep snoring, Sleep suffocation

中图分类号:

R766.9

沈瑶,周成勇. 低温等离子辅助下儿童扁桃体全切除与部分切除的比较[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 22-27.

SHEN Yao, ZHOU Chengyong. Comparison of coblation assisted tonsillectomy and tonsillotomy in children[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(2): 22-27.

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