Velopharyngeal insufficiency following adenoidectomy1

Velopharyngeal insufficiency (VPI) is a well recognized but rare complication of adenoidectomy. Twenty children with this condition were seen and assessed at Great Ormond Street Hospital between 1993 and 2000. The commonest aetiology was occult submucous cleft palate (n = 5) but there was a wide range of other causes. Two children with severe behavioural disorders and normal palates developed mild symptoms, an aetiology not previously reported. Only two children had a classical submucous cleft palate. Nine children required surgical intervention and three revision procedures. Of the 15 treated children for whom follow‐up data was available, 13 regained normal or near‐normal speech. Many cases of postadenoidectomy VPI was not foreseeable. Following referral to a specialist cleft unit, normal or near‐normal speech can be achieved in the majority with a combination of surgery and speech therapy.     

鼻内镜直视下腺样体切除术的临床研究

①目的探讨鼻内镜在腺样体切除术中的作用，并与传统的腺样体切除术相比较。②方法采用经鼻腔内镜下腺样体切除术、经口鼻内镜下腺样体切除术两种术式，共行腺样体切除术62例，治疗因腺样体肥大引起的睡眠打鼾、鼻塞、听力下降等症。③结果术中视野清晰，术后腺样体切除干净，无残体存留。鼻咽部及后鼻孔结构显示良好，无出血及咽鼓管损伤等并发症。全组病例均随访1～3年，临床症状均消失或明显缓解。④结论鼻内镜下腺样体切除术改变了传统腺样体切除术的手术模式，使手术更直观、清晰，增加了手术的安全性和准确性，使病变切除更彻底，提高了手术疗效，减少了并发症的发生。     

Conventional versus endoscopic powered adenoidectomy: A comparative study

Background: Adenoidectomy is a commonly performed ENT surgery. It is conventionally performed using the curettage method. This present article aims to evaluate endoscopic powered adenoidectomy as an alternative.     

儿童腺样体切除术后在麻醉恢复室的护理

目的 探讨小儿腺样体全麻术后在恢复室的护理要点,减少术后并发症的发生。方法 对70例腺样体切除术后患儿进行严密监护, 在麻醉恢复室(PACU)平均监护时间64.29min,动态记录患儿的生命体征、血氧饱和度,严格掌握好拔管的指征,离PACU的标准,针对护理隐患预见性护理。结果 麻醉恢复期发生各种并发症41例（58.57%）,其中舌后坠12例（17.14%）,轻度喉痉挛2例（2.86%）,躁动26例（37.14%）,寒战1例（1.43%）。腺样体切除术后患儿护理效果满意,均安全度过麻醉恢复期。结论 儿童腺样体切除术后易发生躁动、气道梗阻, 应加强安全防护以及呼吸道的管理,以利于减少患儿麻醉后的并发症,提高手术安全性。     

腺样体及扁桃体切除术后应激性胃溃疡出血1例

患儿，男，ll岁，因睡眠时打鼾伴憋气2年，加重3个月入院。临床诊断为腺样体肥大及慢性扁桃体炎。全身麻醉鼻内镜下行腺样体动力刀切除术及双侧扁桃体挤切术。术中经过顺利，出血约80ml，棉球压迫后再以双极电凝行扁桃体窝电凝止血，鼻内镜下检查术区无出血。     

儿童OSAHS的手术疗效分析

目的：探讨扁桃体腺样体切除术治疗儿童OSAHS的疗效。方法全麻下切除扁桃体,鼻内镜下切除肥大的腺样体。结果术后随访6~12个月,临床症状完全消失者370例（92.5%）,21例症状明显减轻（5.25%）,9例症状改善不明显（2.25%）。结论切除扁桃体和腺样体是治疗儿童OSAHS的有效方法。     

鼻内镜辅助经口腔腺样体切除与传统腺样体刮除术临床分析

目的探讨鼻内镜辅助经151腔腺样体切除与传统腺样体刮除术的临床效果及应用价值。方法选择2008年9月～2012年9月东阳市人民医院巍山院区的240例腺样体肥大患者，按照入院时间先后、对照的原则分为观察组和对照组，各为120例。对照组患者采用传统腺样体刮除术进行手术，观察组患者则采用鼻内镜辅助经口腔腺样体切除进行手术。术后随访12个月，观察两组患者临床治疗效果及腺样体残留情况．并比较两组患者并发症发生情况。结果观察组患者临床治疗总有效率为98．3％，对照组患者临床治疗总有效率为90．0％，观察组治疗效果明显优于对照组（P〈0．01）；观察组患者并发症发生率为0．8％，对照组患者并发症发生率为6．6％，观察组明显好于对照组（P〈0．05）。结论临床采用鼻内镜辅助经口腔腺样体切除术式对腺样体肥大患者的治疗效果较好，对患者的创伤小，恢复好．值得临床进一步推广应用。     

Investigation of resectability degree for adenoidal surgery in OSA children with the method of computational fluid dynamics

Conclusion: From aspect of fluid dynamics, expanding patients’ nasopharyngeal coronal-sectional area to 48.3–54.7% of normal area will bring the airflow velocity back to normal in adenoidal hypertrophy children. It might provide a suggestion for adenoidectomy range selection and whether total resection is necessary.

Objectives: To evaluate the nasopharyngeal airflow characteristics in pediatric OSA patients with adenoidal hypertrophy, and to explore the proper resection range for adenoidectomy

Method: Nine OSA patients and four normal children were recruited. The CT scans of their upper airway were collected and used to construct three dimensional models for fluid dynamics analysis. Using computational fluid dynamics, indices such as velocity, pressure, and coronal-sectional area were calculated.

Results: Compared with the normal, the OSA children showed three characteristics in nasopharyngeal: the airflow velocity was significantly higher (p?p?p?>?0.05). In a study of the relationship between velocity and coronal-sectional area, this study investigates different coronal-sectional areas from 30–300?mm². It was found that, when patients’ nasopharyngeal coronal-sectional area was expanded over 155–170?mm², namely 48.3–54.7% of normal area, airflow velocity in nasopharyngeal showed no difference than normal.