目的 探讨扁桃体部分切除术对阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apner hypopnea syndrome，OSAHS）患儿的临床效果。 方法 对中山大学附属第一医院耳鼻咽喉医院2016年8月~2019年1月收治的138例扁桃体肥大合并腺样体肥大的儿童，行扁桃体部分切除术（TT组，69例）和扁桃体全切除术（TE组，69例），比较患儿术后疼痛指数、术中出血量、手术时间、术后出血、术后发热、术后再发上呼吸道炎症、住院时间、术后呼吸暂停低通气指数、术后进食等方面的差异。 结果 TE组患儿相比TT组，术中出血量明显较多，手术时间较长，术后疼痛指数较高，但术后发热更少见。TT组患儿住院时间短于TE组，术后更快恢复进普食。两组患儿术后呼吸暂停低通气指数均较术前明显下降。术后再发上呼吸道炎症两组大致相同。 结论 对于OSAHS患儿，扁桃体部分切除术手术时间短、术中出血更少、术后出血机会更低，且同样达到缓解患儿上呼吸道阻塞的目的，值得临床应用推广。
Abstract
Objective To explore the potential benefits of partial tonsillectomy in the treatment of children with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods From August 2016 to January 2019, 138 patients of tonsil hypertrophy combined with adenoid hypertrophy were treated with partial tonsillectomy(TT group, 69 cases) and total tonsillectomy (TE group, 69 cases). The pain index (PI), intraoperative blood loss (IBL), time of operation (TO) ，the number of postoperative bleeding people (POB) , number of postoperative fever people (PF), number of upper respiratory infections people within 1 year after operation (URIs), hospital-length of stay (HLOS), apnea hyponea index within 2 months after surgery and the amount of time taken to resume a “normal” diet (POFT) between the two groups were compared. Results In patients of the TE group, the average IBL was significantly more than that of the TT group，and the TO was also extended accordingly, while postoperative fever is rare. Due to the more frequently use of bipolar electrocoagulation, the PI of the TE group was also significantly higher than that in the TT group [(5.9 ±0.5) vs (3.1±0.4)]. The PF in the TT group was significantly more than that in the TE group, while the HLOS in the TT group was shorter than that in the TE group [(4.8±2.3) d vs (6.4±1.8) d]. In the TT group, the amount of time taken to resume a “normal” diet was slightly shorter than that in the TE group, but apnea hyponea index of both groups was significantly lower than that before operation. Conclusions The partial tonsillectomy with the advantage of less IBL, low chance of intraoperative bleeding, remission of obstructive sleep apner hypopnea for children, is worth to promote in the clinical application.
关键词
扁桃体炎 /
扁桃体部分切除术 /
扁桃体全切除术 /
睡眠呼吸暂停
Key words
Tonsillitis /
Tonsillectomy /
Tonsillotomy /
Sleep apnea
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参考文献
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基金
广州市科技计划基金（No.201806020125；No.201707 010105）
京ICP备08002354号-3
