鼻内镜下等离子射频治疗儿童腺样体肥大60例分析

目的探讨鼻内镜下运用等离子治疗仪行腺样体射频减容的优点。方法分析60例腺样体肥大儿童接受等离子手术前、后的临床资料,并对术前术后听力、夜间打鼾、鼻塞等症状恢复情况进行观察比较。结果术后腺样体明显缩小,A/N值小于0.6,鼻咽部结构显示良好,无咽鼓管损伤等并发症发生。随访1~2年,患儿症状消失或明显减轻,治疗有效率为100%。结论鼻内镜下运用等离子射频减容手术治疗腺样体肥大是一种安全有效、简单易行的手术方法,值得推广。     

鼻内镜下等离子腺样体射频消融术对儿童慢性鼻窦炎治疗和转归的影响

儿童慢性鼻窦炎在发病因素和治疗方法上有别于成人,已经受到鼻科工作者的重视。近年来有较多学者报道腺样体切除对儿童慢性鼻窦炎的影响,说明腺体肥大是影响儿童慢性鼻窦炎的因素之一。2002-06-2005-06期间我科对152例伴慢性     

鼻内镜下低温等离子射频消融治疗成人腺样体肥大的疗效分析

腺样体亦称咽扁桃体,位于鼻咽顶后壁中线处,在正常生理情况下,6-7岁发育至最大,青春期后逐渐萎缩,在成人则基本消失[1]。成人腺样体肥大临床症状多不典型,常无张口呼吸、打鼾、腺样体面容等典型症状,大多数有不完全性鼻塞、鼻咽异物感、流黏涕等症状,少数伴有头痛、耳闷、耳鸣[2]。我院2009年9月-2012年9月共收治20例成人腺样体肥大患者,均在鼻内镜下经口入路低温等离子射频消融手术治疗,取得满意疗效,现报道如下。     

鼻内镜下低温等离子射频治疗儿童腺样体肥大

2002至2004年我们在鼻窦内窥镜下用低温等离子射频治疗儿童腺样体肥大3l例，男20例，女11例，6—13岁，平均9岁。因鼻塞、打鼾症状就诊28例；单侧或双侧闭塞感症状就诊11例；同时具备上述症状就诊8例。根据手术方式将患儿分为治疗组（A组）与对照组（B组）。A组13例在全麻下行腺样体刮除术；以刮匙匙环紧贴鼻咽顶后壁用力向下刮除腺样体，刮除后迅速以中指探查鼻咽部，若有残留则用较小刮匙补刮，刮除结束后迅速以1至2块湿纱布填塞止血。     

软腭肥厚对低温等离子射频消融术治疗腺样体肥大患儿术后通气功能的影响

目的　探讨软腭肥厚对低温等离子射频消融术治疗腺样肥大患儿术后通气功能的影响，为临床治疗腺样体肥大提供科学依据。方法　选择2013年12月~2019年12月南京医科大学第二附属医院和解放军海军特色医学中心行低温等离子射频消融术的100例腺样体肥大患儿为研究对象。按照患儿检出是否有软腭肥厚情况，分为观察组（软腭肥厚）22例和对照组（无软腭肥厚）78例。记录患儿年 龄、性别、病程、手术时间、临床疗效、护理满意率及术后不良反应发生情况。分别于术前和术后3个月监测氧减指数（oxygen depletion index，ODI）、吸紊乱指数（respiratory disturbance index，RDI）、最长呼吸暂停时间（longest apnea time，LAT）、最低夜间血氧饱和度（lowest oxygen saturation，LSaO2）的变化。结果　两组患儿在性别、年龄、病程及手术时间等的一般资料方面比较，差异无统计学意义（P＞0.05）。治疗前，两组患儿在ODI、RDI、LAT、LSaO2方面，差异无统计学意义（P＞0.05）；治疗后，观察组患儿临床疗效总有效率为72.73%（16/22）低于对照组的80.77%（63/78），差异有统计学意义（P＜0.05）；观察组患儿LSaO2较对照组增长少，在ODI、RDI、LAT方面较对照组降低少，差异有统计学意义（P＜0.05）；观察组护理满意率低于对照组，差异有统计学意义（P＜0.05）；所有患儿均未出现鼻痒、鼻塞、流涕、头晕、嗜睡等情况，行多道睡眠图监测无结果异常。结论　软腭肥厚对低温等离子射频消融术治疗腺样体肥大患儿术后通气功能产生影响，主要表现在ODI、RDI、LAT、LSaO2方面，需要注意定时监测。     

鼻内镜下动力系统切除肥大腺样体

腺样体肥大是儿童及少数成人较常见的引起鼻塞、张口呼吸、打鼾的疾病之一.彻底解决腺样体肥大的方法是手术,但以往传统的手术方式存在着某些弊端.为避免严重并发症的发生,我们于2005年1月～2006年1月对28例腺样体肥大的患者采取鼻内镜下动力系统吸切的方式进行手术,现报告如下.     

腺样体肥大儿童合并慢性鼻-鼻窦炎的临床调查及相关性分析

目的了解腺样体肥大儿童合并慢性鼻-鼻窦炎的情况,计算腺样体肥大儿童中慢性鼻-鼻窦炎的发生率,并分析腺样体肥大与慢性鼻-鼻窦炎的相关性。方法调查128例确诊为腺样体肥大儿童,详细了解其临床表现及治疗现状,收集相关数据并对数据进行统计学分析。结果128例腺样体肥大儿童,年龄3~16岁,平均(8.1±3.5)岁,其中男85例,女43例。并发慢性鼻-鼻窦炎54例(42.2%,54/128),年龄3~16岁,平均(8.4±3.9)岁,各鼻窦受累情况为上颌窦54例,前组筛窦24例,后组筛窦8例,额窦14例,蝶窦6例。54例儿童腺样体肥大程度与鼻-鼻窦炎Lund-Mackay CT评分的秩相关系数为0.485。结论腺样体肥大儿童合并慢性鼻-鼻窦炎的发生率为42.2%,腺样体肥大堵塞鼻咽部并影响鼻腔正常引流是慢性鼻-鼻窦炎的发病机制之一,对于儿童慢性鼻-鼻窦炎合并腺样体肥大者,优先考虑行腺样体切除手术治疗。     

儿童鼻窦炎与腺样体肥大的关系

儿童鼻窦炎发病率高,腺样体肥大是导致儿童鼻窦炎发病的重要原因之一。腺样体肥大可通过影响鼻腔发育、阻碍鼻腔引流和不断释放致病菌而持续影响鼻窦炎的发生发展,鼻窦炎则可通过炎症刺激导致腺样体肥大增生。变态反应因素可同时影响到鼻窦炎和腺样体炎症,是治疗儿童鼻窦炎和腺样体肥大时需要考虑的重要治疗靶点。腺样体与儿童鼻窦炎关系密切互为因果,而腺样体切除术可作为儿童鼻窦炎保守治疗效果不好时的首选外科治疗方案。     

鼻内镜下腺样体切除术治疗儿童腺样体肥大72例

目的 总结鼻内镜直视下行腺样体切除治疗腺样体肥大的优点及疗效.方法 对72例患者均施行全麻下行鼻内镜下腺样体切除术.结果 术后未发生任何并发症,全部患儿术后回访1～3年,未见复发病例.结论鼻内镜下腺样体切除术治疗小儿腺样体肥大安全且疗效显著.     

Assessment of pulmonary function and nasal flow in children with adenoid hypertrophy

OBJECTIVE: Adenotonsillar hypertrophy is the most common cause of upper airways obstruction in children. The consequences of this disorder were analyzed by many researchers. The aim of the study was the assessment of pulmonary function and nasal flow in children with adenoid hypertrophy. METHODS: The study group covered 30 children treated surgically due to adenoid hypertrophy. Nasometric and spirometric tests were performed before and after surgery. RESULTS: The results revealed statistically significant differences between pre- and post-operative values of nasometric flows and the following spirometric parameters: VC, FVC, PEF, FEV1/PEF and FEV1/FVC. CONCLUSION: The influence of adenoid hypertrophy on pulmonary function in children has been confirmed on the basis of the conducted research.     

射频消融治疗下鼻甲肥厚所致鼻塞的疗效

目的 :探讨射频消融治疗下鼻甲肥厚所致鼻塞的效果。方法 :对 18例下鼻甲肥大致鼻塞患者采用射频消融术缩小双侧下鼻甲 ,术前及术后 3个月应用视觉模拟评分表 (VAS)来评价鼻塞的主观感觉。结果 :患者术前鼻塞VAS评分左侧为 (6 7.7± 9.4 ) % ,右侧为 (70 .5± 10 .5 ) % ;术后 3个月左侧为 (4 5 .0± 9.0 ) % ,右侧为(5 3.3± 11.6 ) % ,左右侧分别与术前比较 ,差异均有极显著性意义 (均P <0 .0 1)。随访 3个月 ,检查双侧下鼻甲与鼻中隔的最小距离从术前小于 0 .2cm增加到术后大于 0 .3cm。结论 :射频消融术是安全、有效、微创地治疗下鼻甲肥大所致鼻塞的较好治疗方法     

Alterations of nasal mucociliary transport in patients with hypertrophy of the inferior turbinates, deviations of the nasal septum and chronic sinusitis

Mucociliary transport (MCT) represents the first barrier of the nasal fossae and paranasal sinuses against various biological and physical insults. We studied the nasal MCT time using a mixture of vegetable charcoal powder and 3% saccharin in three groups of patients suffering from hypertrophy of the inferior turbinates, deviations of the nasal septum or chronic sinusitis. The mean values of the nasal MCT in the first two groups were practically identical to the normal ones. In contrast, significantly delayed times were found in patients with chronic sinusitis (P < 0.01). Findings indicate that this delay is determined by an increase in viscoelasticity of the mucus following the acute release of mediators of inflammation, together with a reduction in the periciliary stratum, which slows down the metachronous wave of the MCT. Received: 28 August 1998 / Accepted: 6 January 1999     

腺样体肥大儿童合并慢性鼻窦炎的临床调查及相关性分析

目的　了解本地区腺样体肥大儿童合并慢性鼻窦炎的发病情况,并分析两者之间的相关性。方法　对178例确诊腺样体肥大患儿进行鼻窦CT三围扫描,明确合并慢 性鼻窦炎,进行判定,收集相关数据,行统计学分析。结果  178例腺样体肥大患儿,男107例,女71例,平均年龄7.3±2.5岁。合并慢性鼻窦炎者60例,占33.71%,二者在平均年龄、发病年龄及病程间比较均无显著性差异（P＞0.05）。鼻窦炎CT评分与A/N比值各等级之间比较,差异有统计学意义（r =0.435,P <0.05）。结论　腺样体肥大与慢性鼻窦炎CT评分之间有明显相关性,针对腺样体肥大治疗可明显减缓慢性鼻窦炎病情。     

等离子低温射频消融在二次腺样体手术中的应用

目的:探讨应用等离子低温射频消融系统,切除经传统腺样体刮除术后复发的腺样体的临床疗效和意义。方法:应用等离子低温射频消融系统,结合间接喉镜直视下切除残留或复发腺样体50例。结果:术后随访≥2年,患儿打鼾明显减弱或消失,听力明显改善。结论:应用等离子低温射频消融系统,结合间接喉镜直视下切除经传统腺样体刮除术后复发的腺样体,术野清晰,切除精确,出血少,手术时间短,周围组织无损伤,并发症少,恢复较快。     

Diagnostic accuracy of the nasal obstruction index in detecting adenoid hypertrophy in children without allergy

Objective

We have previously compared the capacity of the nasal obstruction index (NOI) and nasal fiberoptic endoscopy (NFE) to detect adenoid hypertrophy (AH) in children and found no agreement between them. However, the prevalence of false positive results was significantly higher in children with allergic rhinitis (AR), thus suggesting that AR may be a possible causative factor. The aim of this study was to verify the diagnostic accuracy of the NOI in detecting AH by comparing NOI scores with NFE findings in a selected series of non-allergic children affected by nasal obstruction.

Methods

This prospective study was carried out at the Outpatient Clinics of the Departments of Specialist Surgical Sciences and Maternal and Pediatric Sciences of the University of Milan, Italy, and involved 154 non-allergic children aged 3-12 years in whom otological diseases and/or perceived nasal obstruction led to the suspicion of adenoid obstruction. The diagnostic accuracy of NOI was tested at all of the thresholds obtained by combining all of the cut-off points of NFE and NOI.

Results

Sixty-two percent of the children had otological diseases. The choanal opening was completely blocked by the adenoids in 40% of the children, whereas NOI indicated severe clinical obstruction in only 16%. The analysis of diagnostic accuracy showed that sensitivity and specificity were respectively 17-96% and 15-91% depending on the threshold, with no simultaneously acceptable sensitivity and specificity values at any threshold and AUC values of ≤0.7 at all thresholds.

Conclusions

In comparison with NFE, the NOI seems to be inaccurate in detecting AH in non-allergic children with nasal obstruction.     

Sensitivity and specificity of nasal flexible fiberoptic endoscopy in the diagnosis of adenoid hypertrophy in children

OBJECTIVE: To evaluate nasal flexible fiberoptic endoscopy as a diagnostic test of adenoid hypertrophy in children with nasal obstruction. METHODS: One hundred and thirty consecutive children aged 2-12 years were examined from May to October 2005. A questionnaire answered by parents or guardians was used to obtain a symptom score. Adenoid size was measured on radiographs of the nasal cavity using the Cohen and Konak method, and by nasal flexible fiberoptic endoscopy using the Wornald and Prescott classification. The criterion standard was the adenoid size demonstrated on radiograph. RESULTS: The sensitivity of nasal flexible fiberoptic endoscopy was 92% (95% CI, 0.90-0.93), and specificity, 71% (95% CI, 0.70-0.72). The area under the ROC curve was 0.83 (95% CI, 0.76-0.90) at a p<0.001 level of significance. Kappa values were 0.94 (p<0.001) for interobserver agreement, 0.95 (p<0.001) for intraobserver agreement, and 0.54 (p<0.001) for agreement between tests. CONCLUSIONS: Results suggest that nasal flexible fiberoptic endoscopy is a highly accurate diagnostic method. This examination can be performed easily in cooperative children; it is safe, objective and dynamic, and helps to establish diagnoses in difficult cases.     

腺样体消融联合鼓膜打孔术治疗儿童腺样体肥大合并分泌性中耳炎55例

目的 探讨同时运用低温等离子技术开展腺样体消融术联合耳内镜下鼓膜打孔术的前提下,治疗腺样体肥大合并分泌性中耳炎患儿的临床疗效.方法 将确诊为腺样体肥大合并分泌性中耳炎的患儿111例(183耳)随机分为实验组55例(89耳)和对照组56例(94耳),两组均接受鼻内窥镜下腺样体低温等离子消融术,对照组实施鼓膜切开术,实验组...