扁桃体部分切除术联合腺样体切除术治疗儿童OSA的临床分析  

Clinical analysis of tonsillotomy combined with adenoidectomy for children with OSA

作　　者：任妍妍 张庆翔 何双八[1] REN Yanyan;ZHANG Qingxiang;HE Shuangba(Department of Otolaryngology Head and Neck Surgery,Nanjing Tongren Hospital,School of Medcine,Southeast University,Nanjing,211100,China)

机构地区：[1]东南大学附属南京同仁医院耳鼻咽喉头颈外科,南京211100

出　　处：《中国中西医结合耳鼻咽喉科杂志》2024年第5期358-363,374,共7页Chinese Journal of Otorhinolaryngology in Integrative Medicine

基　　金：江苏省自然基金(BK20161116);南京市医学科技发展基金(QRX17033)。

摘　　要：目的探讨扁桃体部分切除术联合腺样体切除术治疗儿童阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)的效果。方法2017年6月~2020年6月在南京同仁医院耳鼻喉科住院治疗的儿童OSA的患者230例,扁桃体部分切除术联合腺样体切除术,共130例,纳入观察组,而把行扁桃体切除术联合腺样体切除术的100例患者纳入对照组,分别比较两组各自的术前术后治疗效果的差异及两组间术后治疗效果的差异。结果观察组及对照组患者术后创面愈合良好,术后AHI较术前有明显下降,最低血氧饱和度较术前有明显升高,其中两组分别比较各自的术前术后差异,差异具有统计学意义(AHI:观察组Z值=13.076,P值<0.001,对照组Z值=15.125,P值<0.001;LSaO2:观察组Z值=9.892,P值<0.001,对照组Z值=9.035,P值<0.001);观察组与对照组分别比较术前及术后6个月的AHI及最低血氧饱和度,差异不具有统计学意义(AHI:术前Z值=1.621,P值=0.105,术后6个月Z值=1.660,P值=0.097,LSaO2:术前Z值=0.853,P值=0.394,术后6个月Z值=1.540,P值=0.123),而观察组术后疼痛轻,恢复常进食时间短,与对照组比较,差异具有统计学意义(两组VAS评分比较Z值=13.180,P值<0.001),而且观察组术后出血、术后感染及咽后壁淋巴组织增生的发生率低于对照组,差异有统计学意义(Z值=4.501,P值=0.034;Z值=4.812,P值=0.028;Z值=5.821,P值=0.016)。结论儿童OSA的手术治疗,扁桃体部分切除术联合腺样体切除术,手术效果好,术后疼痛反应轻,术后并发症少,有很好地就医体验,值得推广应用。Objective To investigate the effect of tonsillotomy combined with adenoidectomy in the treatment of obstructive sleep apnea(OSA)in children.Methods From June 2017 to June 2020,230 children with OSA who were hospitalized in the Department of Otolaryngology,Nanjing Tongren Hospital were included,and 130 children who underwent tonsillotomy combined with adenoidectomy were included in the observation group,while 100 children who underwent tonsillectomy combined with adenoidectomy were included in the observation group.The difference of preoperative and postoperative treatment effect between the two groups and the difference of postoperative treatment effect between the two groups were compared respectively.Results The wounds of the observation group and the observation group healed well,the postoperative AHI decreased significantly,and the lowest oxygen saturation increased significantly.The differences of the indexes with each group before and after surgery were statistically significant(AHI:Z value of the observation group=13.076 P value<0.001,Z value of the observation group=15.125 P value<0.001;LSaO2:Z value of the observation group=9.892 P value<0.001,Z value of the observation group=9.035 P value<0.001;).There was no significant difference in AHI and lowest oxygen saturation between the observation group and the observation group before operation and at 6 months after operation(AHI before operation:Z value=1.621 Pvalue=0.105,AHI at 6 months after operation:Z value=1.660 P value=0.097;LSaO2 before operation:Z value=0.853 Pvalue=0.394,LSaO2 at 6 months after operation:Z value=1.540 P value=0.123),while the observation group had less postoperative pain and shorter time to resume normal eating compared with the observation group,and the difference was statistically significant(VAS score comparison:Z value=13.180 P value<0.001).The incidence of postoperative bleeding,postoperative infection and posterior pharyngeal wall lymphoid hyperplasia in the observation group was lower than that in the observation group,and th

关 键 词：扁桃体部分切除术 扁桃体切除术 阻塞性睡眠呼吸暂停 儿童 

分 类 号：R766.9[医药卫生—耳鼻咽喉科]