扁桃体腺样体肥大患儿术前术后血气分析

目的探讨儿童病理性扁桃体腺样体肥大低通气对血气的影响。方法对已确诊的12例扁桃体肥大、8例腺样体肥大及21例扁桃体合并腺样体肥大患儿手术前的动脉血气分析进行检则并与术后对比。结果所有患儿术前均出现不同程度的动脉氧分压降低,二氧化碳升高,部分伴有低氧血症、高碳酸血症。比较术前、术后动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)均有统计学意义。结论扁桃体腺样体肥大可导致儿童长期慢性缺氧影响内环境平衡及生长发育,建议积极治疗。     

儿童阻塞性睡眠呼吸障碍患者腺样体和扁桃体增生的临床特征及其相关性研究

目的 通过对因腺样体和/或扁桃体增生导致儿童阻塞性睡眠呼吸障碍(OSDB)需要手术的病例资料分析,探讨儿童OSDB患者腺样体和扁桃体增生程度的临床特征及相关性。方法 提取前瞻性病例数据库中737例因腺样体和/或扁桃体增生导致OSDB进行了腺样体和/或扁桃体切除术患儿的临床资料。把性别、年龄、腺样体大小、扁桃体大小等设为观察指标。对数据进行统计学分析,对相关问题进行讨论。结果 在儿童OSDB患儿中：①腺样体增生程度随年龄上升呈下降趋势,扁桃体增生程度则随年龄增加呈上升趋势,差异具有统计学意义(P＜0.01)。②腺样体和扁桃体增生程度平均得分均值差异具有统计学意义(P＜0.01),腺样体增生程度高于扁桃体增生程度;这种差异在<6岁年龄段的儿童中尤其显著。③腺样体和扁桃体增生程度与性别无关(P均>0.05)。④腺样体增生程度与年龄呈负相关(r=-0.210,P＜0.01);扁桃体增生程度与年龄呈正相关(r=0.175,P＜0.01);腺样体增生与扁桃体增生呈负相关(r=-0.119,P=0.001)。结论 在儿童OSDB患者中,腺样体和扁桃体的增生具有不同的趋势和特点;腺样体增生程度与年龄呈负相关,扁桃体增生程度与年龄呈正相关;总体上腺样体的增生程度高于扁桃体,腺样体的增生对儿童OSDB贡献度较扁桃体大。     

内镜手术治疗腺样体肥大致儿童分泌性中耳炎

目的：探讨腺样体肥大致儿童分泌性中耳炎的诊治方法和手术效果。方法：对37例患儿行内镜下腺样体切除＋鼓膜置管术。结果：患儿术后听力均提高,拔管后随访13～17个月未见复发。结论：内镜下腺样体切除＋鼓膜置管术对腺样体肥大致儿童分泌性中耳炎有确切疗效。     

儿童腺样体肥大合并慢性鼻窦炎对分泌性中耳炎发生率的影响

目的探讨儿童腺样体肥大(AH)合并慢性鼻窦炎(CRS)对分泌性中耳炎(OME)发生率的影响。方法对我院2017年至2018年行腺样体切除术或腺样体扁桃体切除术的腺样体肥大患者的临床资料进行统计和分析,包括病史和体征,电子鼻咽镜检查,声阻抗测试以评估腺样体肥大患者分泌性中耳炎和慢性鼻窦炎的患病情况。并使用统计软件SPSS 24.0进行统计分析。结果在208例AH儿童中,有分泌性中耳炎的50例(24%),在学龄儿童(6~12岁)腺样体肥大患者中分泌性中耳炎的发生率最高。腺样体肥大组和腺样体肥大合并慢性鼻窦炎组之间分泌性中耳炎的发生率在统计学上有差异(P=0.001)。结论患有慢性鼻窦炎的腺样体肥大儿童患分泌性中耳炎的风险相应增加,而学龄期的腺样体肥大儿童分泌性中耳炎发生率最高。     

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。     

Prevalence and associated factors of pulmonary hypertension in Kenyan children with adenoid or adenotonsillar hypertrophy

Objectives

Adenotonsillar hypertrophy is a common condition in childhood, whose serious complications of pulmonary hypertension and cor pulmonale are devastating but local prevalence is unknown. This study determined the prevalence and associated factors of pulmonary hypertension in children with adenoid or adenotonsillar hypertrophy at Kenyatta National Hospital, Kenya.

Methods

This was a cross sectional hospital based survey conducted among children below 12 years of age with clinical and radiological adenoid hypertrophy attending the ear, nose and throat (ENT) outpatient clinic and general pediatric wards. Doppler echocardiography was used to determine pulmonary hypertension defined as a mean pulmonary arterial pressure (mPAP) of ≥25 mm Hg using the Chemla equation. Children with mPAP of ≥25 mm Hg were compared to those with lower pressures and clinical and radiological factors associated with pulmonary hypertension determined using multivariate logistic regression analysis.

Results

Of the 123 eligible children in the study, 27 had pulmonary hypertension giving a prevalence of 21.9% (95% CI 14.64%–29.27%). Independent factors associated with pulmonary hypertension included nasal obstruction (OR = 3.0 [95% CI 1.08–8.44] p = 0.035) and hyperactivity on history (OR = 0.2 [95% CI 0.07–0.59] p = 0.003) and adenoid-nasopharyngeal ratio (ANR) >0.825 on lateral neck radiography (OR = 5.0 [95% CI 1.01–24.37] p = 0.048).

Conclusion

One in five children with adenoid or adenotonsillar hypertrophy had pulmonary hypertension with a 3-fold and 5-fold increased odds in those with nasal obstruction on history and ANR >0.825 on lateral neck radiography respectively and an 80% reduced odds in reportedly hyperactive children.     

建立扁桃体腺样体不同手术方式对儿童阻塞性睡眠呼吸暂停低通气综合征疗效的系统评价体系

目的 探讨建立比较分析不同的扁桃体腺样体手术方式对儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)疗效的系统评价体系。 方法 计算机检索中国知网、万方数据库、中国生物医学文献数据库和维普数据库中关于扁桃体腺样体不同手术方式治疗儿童OSAHS的随机对照试验,时限为从建库到2016年7月。对纳入研究的质量进行严格评价与提取资料,对符合标准的文献进行系统评价,统计学处理分析应用RevMan 5.0软件。 结果 共纳入7篇随机对照试验。结果显示观察组与对照组的治愈率、有效率、术后低通气指数(AHI)及最低血氧饱和度(LSaO₂)的比较,其差异均无统计学意义(P>0.05);而观察组的手术时间及术中出血量均少于对照组,两者间差异均有统计学意义(P<0.05)。只有1篇对比了腺样体切除伴扁桃体部分及全切术术前及术后6个月时体液免疫及细胞免疫指标的改变,无法进行Meta分析,故未能提供循证医学证据。 结论 目前不同术式对患儿免疫功能的影响及治疗效果的研究较少,而且术后观察时间不一致,但这些可查询到的研究均表明腺样体切除伴部分扁桃体切除术不会对儿童的体液及细胞免疫功能造成不良影响。8岁以下且扁桃体仅单纯增生肥大的OSAHS患儿,部分扁桃体切除+腺样体切除术既可改善通气障碍,又能保留扁桃体的免疫功能及减少手术时间和术中出血量,是治疗该类患者的理想方法。     

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。     

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.     

替牙期扁桃体伴腺样体肥大患儿过敏因素与颌面畸形的相关性

目的 研究替牙期扁桃体伴腺样体肥大患儿过敏因素与颌面部畸形的相关性.方法 对2018-2021年在山东大学齐鲁医院耳鼻咽喉科住院行扁桃体及腺样体切除术的替牙期(6-12岁)儿童207例行过敏原检测,收集患儿一般资料、临床资料及头影测量指标,组间比较采用t检验或非参数检验,相关分析使用Pearson或Spearman相关...     

儿童阻塞性睡眠呼吸暂停低通气综合征扁桃体腺样体评价

目的探讨儿童扁桃体和/或腺样体肥大与阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS)的相关性。方法对3～12岁的79例儿童鼾症患者及27例无鼾症儿童进行扁桃体大小及鼻内镜下腺样体大小的评价。对全部打鼾儿童进行多导睡眠监测(polysomnography,PSG)区分单纯性鼾症(primarysnoring,PS)和OSAHS,并了解他们的睡眠结构及呼吸紊乱情况,其中33例打鼾儿童进行了声阻抗检查。结果38例(66.7%)OSAHS儿童集中在3～6岁年龄阶段,单纯性鼾症儿童分布较均匀。3组间的扁桃体大小差异不显著(P>0.05),而腺样体大小差异有显著性,PS组和OSAHS组Ⅲ、Ⅳ级比例有明显增高的趋势(P<0.05)。扁桃体和腺样体均达到Ⅲ、Ⅳ级的对照组为22.2%、PS组为40.9%、OSAHS组为43.9%,虽有增高趋势但组间差异不显著(P>0.05)。PS和OSAHS两组Ⅰ期、Ⅱ期、慢波睡眠期、REM睡眠期的比例及进入睡眠的潜伏期、睡眠效率及觉醒指数基本一致(P>0.05),而最低血氧饱和度、平均血氧饱和度及睡眠呼吸暂停低通气指数(apneahypopneaindex,AHI)两组间有显著性差异(P<0.05)。两组儿童伴发鼻窦炎的情况为PS组6/22(27.3%),OSAHS组12/57(21.1%);伴发分泌性中耳炎的情况为PS组4/22(18.2%),OSAHS组11/57(19.3%),两组差异不显著(P>0.05)。结论PS和OSAHS的儿童睡眠结构差异不明显,伴发鼻窦炎、分泌性中耳炎的情况相似。在引起打鼾和OSAHS的阻塞性原因中,扁桃体的作用不明显,腺样体肥大与OSAHS之间有相关性,但不是导致OSAHS的唯一病因。     

儿童慢性鼻窦炎合并腺样体肥大菌谱及预后相关因素分析

目的 分析慢性鼻窦炎(CRS)合并腺样体肥大患儿腺样体表面及鼻腔内细菌谱,比较腺样体手术对CRS的临床疗效及相关因素分析.方法 收集2017年10月—2019年10月就诊于北京儿童医院耳鼻咽喉科的30例CRS合并腺样体肥大患儿的相关临床资料,其中男22例,女8例.所有患儿均行腺样体和/或扁桃体切除术,术中采集腺样体表面...     

电子鼻咽喉镜在小儿腺样体肥大诊治中的应用

目的 探讨电子鼻咽喉镜在小儿腺样体肥大诊治中的应用。方法 对578例具有上气道阻塞症状的患儿（病例组）采用电子鼻咽喉镜检查，分析腺样体增大程度与上气道阻塞的关系及其可行性。结果 ①本组病例中，411例能主动配合，119例稍有哭闹，仅48例是在协助固定体位下进行。②14例因鼻中隔偏曲导致一侧后鼻孔和鼻咽部无法检查，5例因双侧鼻腔狭窄无法检查，其余559例均可检查。③559例均有不同程度的腺样体增大。④29例在检查中出现鼻黏膜少量出血，未引发其他并发症。结论 电子鼻咽喉镜检查适合于小儿，该法直观、准确、安全，是判断小儿腺样体肥大最有效、最直观的检查方法。Ⅳ°腺样体是小儿上气道阻塞的主要病因，是手术治疗的适应证。     

An analysis of the incidence of adenoid hypertrophy in allergic children

INTRODUCTION: The adenoidectomy is the most often made operation in small children but the reasons of adenoid hypertrophy are not completely explained. Some researches show that in part of children, allergy can be a risk factor for adenoid hypertrophy. The main aim of this study was the analysis of adenoid hypertrophy in children with different allergic diseases. MATERIAL AND METHODS: Two separate groups of children were examined. The study group consisted of 436 children between 4 and 9 years old with allergic rhinitis and/or bronchial asthma and/or atopic dermatitis hypersensitive to house dust mites (interview, positive skin-prick test results). The control group consisted of 229 non-atopic children (negative interview and skin-prick tests) in the similar age. In the both groups we examined the incidence of adenoid hypertrophy and its dependence of the kind of allergic disease, age, sex, infections, results of skin-prick test and other sensitization. RESULTS: The probability of adenoid hypertrophy was statistically more significant (logistic regression analysis) only in children from the study group with allergic rhinitis. There were no differences in adenoid hypertrophy incidence between children with other allergic diseases and the control group. The children from the study group with adenoid hypertrophy were more often hypersensitive to pollen and moulds allergens than the children without adenoid hypertrophy (chi square test). But there were no differences in the incidence of infection, age, sex and results of skin-prick tests. CONCLUSION: The result of our study suggests that the chance of adenoid hypertrophy in allergic children hypersensitive to dust mites is greater only in them with allergic rhinitis.     

腺样体肥大患儿血清特异性及总IgE检测结果分析

目的 初步分析腺样体肥大患儿血清特异性IgE分布及总IgE水平,探讨特异性IgE及总IgE水平与腺样体大小的关系.方法 回顾性分析2018年8月16日-2020年10月19日进行腺样体手术的186例腺样体肥大患儿的血清特异性IgE、总IgE检测结果,分析腺样体肥大患儿血清IgE分布情况,并比较患儿腺样体肥大程度与血清特...     

Relation of mean platelet volume with obstructive adenoid hypertrophy in children

Objective

Adenoid hypertrophy (AH) is a common etiology of chronic upper airway obstruction. Upper respiratory tract obstruction may cause chronic alveolar hypoventilation and pulmonary vasoconstriction. In one previous study in patients with obstructive sleep apnea (OSA), it has been claimed that mean platelet volume (MPV), an indicator of platelet activation is increased and that MPV has an important role in the pathophysiology of cardiovascular diseases. We investigated in our study if MPV can be used as an indicator of obstruction due to adenoid hypertrophy.

Methods

Our study includes 61 children that underwent adenoidectomy with a mean age of 7.12 (±2.373). White blood cell, platelet count, MPV, platelet crit and platelet distribution width levels were measured before and 3 months after adenoidectomy. Children’s symptoms for upper airway obstruction (UAO) (presence of snoring, mouth breathing or difficulty in breathing during sleep, obstructive breathing or apnea during sleep) were questioned in the preoperative and postoperative period by a standardized questionnaire.

Results

There was no significant difference between preoperative and postoperative mean values of MPV, hemoglobin, platelet count (p > 0.05). White blood cell levels were significantly higher in the preoperative period values compared with postoperative period values (p < 0.05). Preoperative UAO scores were significantly higher than the postoperative UAO scores. After stratification of the degree of obstruction (as mild, moderate and severe) there was no significant difference in between groups in terms of MPV values.

Conclusion

There was no significant relation between MPV levels and obstructive adenoid hypertrophy.     

Prevalence of adenoid hypertrophy and nocturnal enuresis in primary school children in Istanbul, Turkey

OBJECTIVE: The purpose of this study is to investigate the prevalence of an existing relationship between adenoid hypertrophy and nocturnal enuresis in primary school children. METHODS: The study was performed in four primary schools that were chosen randomly in Kartal, Istanbul. The children's parents were asked to fill out a questionnaire that included questions concerning the associated symptoms of adenoid hypertrophy and nocturnal enuresis. The interrelations between adenoid hypertrophy and nocturnal enuresis items were examined by X2 tests. RESULTS: The study population consisted of 1132 (625 girls, 621 boys) primary school children between 5 and 14 years of age (mean 9.59+/-2.60 years). The children were divided into three groups with 5-7 years old children in Group I (n=232), 8-10 years old children in Group II (n=506) and 11-14 years old children in Group III (n=394). Of the 1132 distributed questionnaires, 1090 (87.4%) were filled in adequately and were accepted for evaluation. Prevalence of adenoid hypertrophy in school children was found to be 58 in Group I (27%), 94 in Group II (19.5%) and 78 in Group III (19.9%). Prevalence of nocturnal enuresis in school children was found to be 35 in Group I (15.1%), 51 in Group II (10.1%) and 18 in Group III (4.6%). No statistically significant association was present between adenoid hypertrophy and nocturnal enuresis in either Group I, II or III school children. CONCLUSION: In contrast to previous studies, our prevalence study did not find an association between adenoid hypertrophy and nocturnal enuresis. Thus, this prevalence study provides otolaryngologists new and interesting information.     

糠酸莫米松鼻喷剂联合玉屏风颗粒可提高儿童腺样体肥大疗效

目的 探讨糠酸莫米松鼻喷剂联合玉屏风颗粒治疗儿童腺样体肥大的疗效。 方法 采用前瞻性随机对照研究,对90例4~10岁腺样体肥大儿童单用糠酸莫米松鼻喷剂或联合玉屏风颗粒口服治疗8周,对比治疗前后患儿临床症状积分,内镜下观察腺样体变化,记录上呼吸道感染次数。 结果 对照组(鼻喷激素)临床症状总积分减少19.5%,鼻咽阻塞程度从82.2%下降到73.6%(P<0.01),上呼吸道感染次数大于1次者占44.19%;试验组(联合用药)临床症状总积分减少31.7%,鼻咽阻塞程度从85.4%下降到71.4%(P<0.01),上呼吸道感染次数>1次者占16.67%。 结论 糠酸莫米松鼻喷剂治疗儿童腺样体肥大有效,联合玉屏风颗粒可进一步提高疗效,并可减少儿童上呼吸道感染的发生率。     

腺样体肥大对不同年龄段儿童牙颌面部发育的影响

目的 观察腺样体肥大在不同年龄组儿童牙颌面部发育的临床表现。方法 运用计算机辅助X线头影测量技术,将68例腺样体肥大患儿(a/n≥0.71)分为A组25例(3～4岁,病程2～3年)、B组27例(5～6岁,病程2～4年)及C组16例(7～8岁,病程3～5年);同时选择20例健康儿童(3～8岁)作为对照组,行X线头影测量。结果 A、B、C三组分别与对照组比较,ANB角、上下中切牙角均减小(P<0.01),FH-MP、Y轴角、ABS-PNS值等均增大(P<0.01)。A组与C组比较,ANB、FH-MP、Y轴角、ABS PNS等均减小(P<0.05),上下中切牙角增大(P<0.05)。C组与对照组比较,SNB值减小(P<0.05),L1-NB增大(P<0.05),其余组间比较差异无统计学意义。结论 腺样体肥大对儿童的牙颌面部发育有一定影响,且病程越长影响越明显。     

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。