扁桃体部分切除与全切对有反复呼吸道感染史的儿童OSAHS患儿免疫功能的影响  

Effect of partial and total tonsillectomy on the immune function of children with obstructive sleep apnea hypopnea syndrome who have a history of recurrent respiratory tract infections

作　　者：王帅 张强 骆宝民 WANG Shuai;ZHANG Qiang;LUO Bao-min(Department of Otolaryngology,the Third People's Hospital of Puyang,Puyang 457000,Henan,CHINA)

机构地区：[1]濮阳市第三人民医院耳鼻喉科,河南濮阳457000

出　　处：《海南医学》2024年第17期2464-2469,共6页Hainan Medical Journal

基　　金：2022年河南省科技攻关项目(编号:222102311446)。

摘　　要：目的探讨扁桃体部分切除与全切对有反复呼吸道感染史的儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿免疫功能的影响。方法选取2020年1月至2023年8月濮阳市第三人民医院耳鼻喉科收治的30例行扁桃体部分切除术OSAHS患儿(部分切组)和30例行扁桃体全切术OSAHS患儿(全切组)进行回顾性研究,两组患儿均有反复呼吸道感染史。比较两组患儿的手术情况、术前与术后3个月的免疫功能[总T淋巴细胞、总B淋巴细胞、CD4^(+)/CD8^(+)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)、补体C3和C4],统计术后6个月的呼吸道感染率。结果部分切组患儿的手术时间为(22.35±4.84)min,明显长于全切组的(14.10±2.37)min,术后疼痛时间和假膜脱落时间分别为(3.03±0.79)d、(11.79±2.05)d,明显短(快)于全切组的(4.59±1.28)d、(14.00±1.96)d,差异均有统计学意义(P<0.05),但两组患儿的术中出血量比较差异无统计学意义(P>0.05);术后3个月,全切组学龄前患儿的总T淋巴细胞、总B淋巴细胞、CD4^(+)/CD8^(+)、IgA、IgM、IgG、补体C3和C4明显低于术前,差异均有统计学意义(P<0.05);术后3个月,全切组学龄期患儿总T淋巴细胞、总B淋巴细胞、CD4^(+)/CD8^(+)、IgA、IgM、IgG、补体C3和C4与术前比较差异均无统计学意义(P>0.05);术后3个月,部分切组学龄前与学龄期患儿总T淋巴细胞、总B淋巴细胞、CD4^(+)/CD8^(+)、IgA、IgM、IgG、补体C3和C4与术前比较差异均无统计学意义(P>0.05);术后6个月全切组学龄前患儿呼吸道感染率为26.67%,明显高于学龄期患儿的3.33%,差异有统计学意义(P<0.05),但术后6个月部分切组学龄前患儿呼吸道感染率与学龄期患儿比较差异无统计学意义(P>0.05)。结论与扁桃体全切术比较,扁桃体部分切除术更适用于各个年龄段有反复呼吸道感染史的儿童OSAHS患儿,可减少对免疫功能的影响,并降低术后呼吸道感染率。Objective To investigate the effects of partial and total tonsillectomy on the immune function of children with obstructive sleep apnea hypopnea syndrome(OSAHS)who have a history of recurrent respiratory tract infections.Methods Thirty children with OSAHS who underwent partial tonsillectomy(partial resection group)and 30 children with OSAHS who underwent total tonsillectomy(total resection group)in the Department of Otolaryngolo-gy,the Third People's Hospital of Puyang from January 2020 to August 2023 were selected.Both groups of children had a history of recurrent respiratory tract infections.The surgical conditions and the immune functions(total T lymphocytes,total B lymphocytes,CD4^(+)/CD8^(+),immunoglobulin A[IgA],immunoglobulin M[IgM],immunoglobulin G[IgG],com-plement C3,C4)before surgery and at 3 months after surgery were compared between the two groups,and the respirato-ry tract infection rate at 6 months after operation was counted.Results The operation duration of patients in the partial resection group was(22.35±4.84)min,which was significantly longer than(14.10±2.37)min in the total resection group,while the postoperative pain time and pseudomembrane shedding time were(3.03±0.79)d and(11.79±2.05)d,respec-tively,significantly shorter(faster)than(4.59±1.28)d and(14.00±1.96)d in the total resection group,with statistically significant differences(P<0.05).There was no statistically significant difference in the intraoperative blood loss between the two groups(P>0.05).At 3 months after operation,the total T lymphocytes,total B lymphocytes,CD4^(+)/CD8^(+),IgA,IgM,IgG,complement C3 and C4 of preschool children in the total resection group were significantly lower than those be-fore operation(P<0.05).At 3 months after operation,the above indexes in the school-age children in the total resection group showed no significant difference with those before surgery(P>0.05).At 3 months after operation,there was no sig-nificant difference in the above indexes between pre-school and school-age children in partial

关 键 词：儿童 扁桃体切除术 呼吸道感染 阻塞性睡眠呼吸暂停低通气综合征 免疫功能 

分 类 号：R725.6[医药卫生—儿科]