慢性扁桃体炎合并慢性肾炎患者切除扁桃体的的效果观察

目的分析耳鼻咽喉科老年患者多重耐药菌感染的临床特征和耐药性。方法研究对象200例,均为我院2019年1月到2020年1月之间收治的慢性扁桃体炎合并慢性肾炎患者,按照随机数字法分为对照组和观察组各100例,对照组选择切除扁桃体,观察组选择不切除扁桃体,对两组患者的24h蛋白尿和血尿水平进行比较。结果对照组患者治疗后的24h尿蛋白和血尿均低于观察组,差异有统计学意义(P<0.05),SCr和Ccr水平无显著差异(P>0.05)。两组不良反应发生率无显著差异(P>0.05)。结论慢性扁桃体炎合并慢性肾炎患者切除扁桃体后具有一定的疗效,可降低尿蛋白和血尿指标,对肾功能无显著影响,安全可靠,具有临床借鉴价值。     

扁桃体切除术对儿童发育的影响

随着免疫学的进展,对扁桃体切除手术有了新的看法,有人认为扁桃体切除手术是促使少年生长加速的原因之一,因而近年学龄儿童施行扁桃体切除术的在减少。作者等为研究扁桃体切除手术对儿童发育的影响,对莫斯科1～10年级的7～17岁学生进行了观察。施行扁桃体切除术2年以上者553人,其中369人无慢性伴随疾病,184人有慢性伴随疾病(代偿期);患中毒过敏型慢性扁桃体炎者189例;对照组健康儿童1821例。本文将儿童发育情况分为超重型、体重不足和发育迟缓三类。扁桃体切除术后儿童与健康儿童比较,超重型者增多,以女性明显,但差异性分析说明手术并非决定体重超常的因素。切除扁     

重组人表皮生长因子在扁桃体切除术后的应用

目的观察重组人表皮生长因子(rhEGF)减轻扁桃体术后疼痛、促进创面愈合的作用。方法30例因慢性扁桃体炎或扁桃体肥大而行扁桃体切除的病例分为两组。治疗组用rhEGF治疗,对照组使用复方硼砂液漱口,比较两组的疼痛缓解时间及创面愈合时间。结果治疗组:平均疼痛缓解时间(3.4±0.9)d,平均创面痊愈时间(7.9±1.4)d。对照组:平均疼痛缓解时间(5.2±1.5)d;平均创面痊愈时间(10.8±2.1)d。治疗组的疼痛缓解时间和创面愈合时间明显短于对照组(P<0.01)。结论局部应用rhEGF可有效促进扁桃体切除术后恢复。     

呼吸面罩内压力变化对阻塞性睡眠呼吸暂停低通气综合征患者上呼吸道形态的影响

目的:探讨呼吸面罩内压力变化对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者和正常人上呼吸道形态的影响.方法:采用16排螺旋CT自鼻咽顶部到声门之间的区域进行连续扫描,应用图像工作站测量软腭后区、悬雍垂区、舌后区和会厌后区的气道横截面积、左右径和前后径.对35例正常对照者和46例OSAHS患者分别行面罩内压力为0 kPa和0.784 kPa状态下的CT扫描,比较正常对照者和OSAHS患者间在各种条件下上呼吸道各测量指标的差异.结果:在面罩内压力相同的条件下,OSAHS患者上呼吸道CT测量的多数指标明显小于对照组(P<0.05或P<0.01);对照组和OSAHS患者上呼吸道多数测量指标在0.784 kPa正压条件下较0 kPa时有明显增加(P<0.05或P<0.01),其中对照组的增加幅度明显大于OSAHS组(P<0.05或P<0.01);以35例对照者确定面罩内压力由0 kPa增加到0.784 kPa时上呼吸道软腭后区、悬雍垂区、舌后区和会厌后区横截面积增加的最小正常值为标准,将46例OSAHS患者分为上气道正常扩张的17例和扩张度低于正常的29例,在0 kPa下这2组患者上呼吸道CT测量指标差异无统计学意义(P>0.05);而在0.784 kPa条件下,前者的上呼吸道多项测量指标均大于后者(P<0.05或P<0.01).结论:面罩内压力的增加可以在不同程度上导致OSAHS患者和对照者上呼吸道的扩张,其中OSAHS患者的扩张程度明显小于对照者;OSAHS患者上呼吸道扩张程度较小的原因与其上呼吸道存在解剖性狭窄和咽壁本身的可扩张性减弱有关.     

剥离法与挤切法结合在成人扁桃体切除术中的应用

目的 探讨剥离法与挤切法相结合实施成人扁桃体手术临床效果。方法 慢性扁桃体炎成人患者238例,130例采用剥离与挤切相结合(治疗组)的手术方法,108例采用传统的剥离法(对照组)。结果 治疗组手术时间较对照组短,术中出血量较对照组少,差异有统计学意义(P＜0.01);治疗组无原发性出血病例,对照组2例原发性出血病例;两组均无继发性出血病例。结论 采用剥离与挤切相结合的方法切除成人扁桃体,简便易行,术中出血少,术时短,痛苦小。     

手术结束前升高血压对减少低温等离子扁桃体切除术后出血的疗效观察

目的　比较手术结束前升高血压检查扁桃体术腔与常规检查扁桃体术腔两种方法对扁桃体切除术后出血的影响。方法　对我院2008年1月～2016年1月行全麻下低温 等离子扁桃体切除术的患者1069例,采用回顾性临床病例对照研究方法,分为手术结束前升高血压检查扁桃体术腔组546例（治疗组）与常规检查扁桃体术腔组523例（对照组）,比较两组的术后出血发生率、术后出血量等。结果　治疗组原发性出血6例,发生率1.10%,继发性出血9例,发生率1.65%。对照组原发性出血17例,发生率3.25%,继发性出血5例,发生率0.96%。扁桃体切除后手术结束前升高血压检查扁桃体术腔,可减低术后原发性出血概率,而与术后继发性出血无明显相关。结论　手术结束前升高血压检查扁桃体术腔能有效减少低温等离子扁桃体切除术后原发性出血发生概率。     

运用单极电刀与传统方法实施扁桃体切除术治疗睡眠呼吸暂停综合征疗效比较

目的 比较分析单极电刀扁桃体切除术与传统扁桃体剥离术的疗效,区别优缺点。方法 由于扁桃体肥大引起阻塞性睡眠呼吸暂停低通气综合征(OSAHS)或慢性扁桃体炎而需要切除双侧扁桃体的患儿80例,实施双侧扁桃体切除治疗。其中行单极电刀扁桃体切除术40例（A组）,行传统扁桃体切除术40例（B组）。分析两个组在手术时间、术中出血量、术后疼痛程度方面的差异。结果 两组在手术时间、术中出血量方面差异有统计学意义（P<0.05）;疼痛程度差异无统计学意义。两组患儿术后均未发生出血。结论 单极电刀切除儿童扁桃体安全,术中出血量少,手术效率提高。     

超声刀在儿童扁桃体切除中的应用

目的探讨超声刀在儿童扁桃体切除中的优点及其应用价值。方法采用完全随机分组的方法 ,一组采用超声刀切除扁桃体;对照组应用剥离法切除扁桃体。均在全身麻醉下进行,对比两组病例的术中出血量,手术时间,术后疼痛程度,以及术后并发症的情况。结果两组病例中,超声刀组术中出血量明显少于剥离组,手术时间明显缩短,术后疼痛及术后并发症情况无明显差异。结论超声刀切除扁桃体具有切割精确,出血少,能缩短手术时间。     

从扁桃体功能来看扁桃体摘除术的问题

近十多年来,由于免疫学的进展,关于扁桃体的生理功能及扁桃体摘除术的指征等,提出了一些新的问题,现综合部分文献如下,供参考。一、扁桃体的生理功能扁桃体虽无输入淋巴管,但公认其为一淋巴器官,具免疫功能。淋巴组织是人体免疫活动的基础,它分为中央型和周围型二类。前者直接来源于肠上皮或与肠上皮紧密结合的组织,主要的代表是胸腺。由第三、第四咽囊发育而来。在鸟类,胸腺和法氏囊(Bursa of Fabricius)共同负责免疫活动。胸腺产生小淋巴细胞,与抗原起反应,法氏囊负责产生抗体的浆细胞,在功能上两者虽有区别,但也有联系。鸡切除法氏囊,过一段时间胸腺皮质萎缩,脾变小,不仅影响抗体产     

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。     

Tonsillectomy and the immune system: a long-term follow up comparison between tonsillectomized and non-tonsillectomized children

Immunological functions of the tonsils and possible effects of their removal are still controversial. One reason for this is the lack of long-term follow-up investigations after tonsillectomy. In the present study selected parameters of the cellular and Immoral immune systems of 160 children 0.5–11 years after tonsillectomy (mean 6.6 ± 2.1 years) were compared to those of 302 age-matched non-tonsillectomized children. In tonsillectomized children the incidence of infections of the upper respiratory tract was not increased compared to the non-tonsillectomized control group. Slightly increased percentages of CD 21+ cells, raised counts of CD4+ cells, absolute and relative increases in DR+ cells and a raised CD4+ DR count was found mainly in tonsillectomized boys, while lymphocyte subpopulations of tonsillectomized girls remained unaffected. Tonsillectomized children had lower IgA levels, but the complement system was not altered in either sex. These findings show that while tonsillectomy may lead to certain changes in the cellular and humoral immune systems, these alterations are clinically insignificant and no increased frequency of immunomodulated diseases should be expected.     

Long term outcome of tonsillar regrowth after partial tonsillectomy in children with obstructive sleep apnea

Objective

We investigated the long-term effects of partial tonsillectomy, and potential risk factors for tonsillar regrowth in children with obstructive sleep apnea hypopnea syndrome (OSAHS).

Methods

Children affected by OSAHS with obstructive hypertrophic tonsils underwent partial tonsillectomy or total tonsillectomy with radiofrequency coblation. Polysomnography was performed prior to and 5 years following surgery. Blood samples from all participants were taken prior to and 1 month following surgery to assess immune function. All participants were interviewed 5 years following surgery to ascertain effects of the surgery, rate of tonsillar regrowth, and potential risk factors.

Results

All parents reported alleviation of breathing obstruction. Postoperative hemorrhage did not occur in the partial tonsillectomy group compared to 3.76% in the total tonsillectomy group. Tonsillar regrowth occurred in 6.1% (5/82) in children following partial tonsillectomy. Palatine tonsil regrowth occurred a mean of 30.2 months following surgery, and 80% of children with tonsillar regrowth were younger than 5 years of age. All five patients had a recurrence of acute tonsillitis prior to enlargement of the tonsils. Four of the five had an upper respiratory tract allergy prior to regrowth of palatine tonsils. There were no differences in IgG, IgM, IgA, C3, or C4 levels following partial tonsillectomy or total tonsillectomy.

Conclusion

Partial tonsillectomy is sufficient to relieve obstruction while maintaining immunological function. This procedure has several post-operative advantages. Palatine tonsils infrequently regrow. Risk factors include young age, upper respiratory tract infections, history of allergy, and history of acute tonsillitis prior to regrowth.     

Image cytometry appliance in chronic tonsillitis

Enlargement of palatinar tonsils in the course of chronic inflammatory process has been thought till now to reflect pronounced lymphocyte proliferation even if such mechanism fails to explain the persistent increase in size of the organ. The studies were performed on 92 tonsils obtained from 4 to 16 years old children in whom the tonsils were removed due to chronic inflammatory processes in upper respiratory tract or in ears. Cell proliferation and apoptosis were evaluated by flow cytometry and by image analysis. The data show that apoptosis in the tonsils is accompanying lymphocyte proliferation in the course of chronic inflammatory process. Evaluation of homeostasis in palatine tonsils could be helpful in referring children for tonsillectomy. Imagine analysis may objectivize and specify diagnosis of chronic tonsillitis.     

上皮源性细胞因子在共同气道疾病中的作用及其研究进展

在"一个气道一种疾病"的概念下,上下气道炎症性疾病通常是并存的,整个气道可以看作一个器官.上呼吸道和下呼吸道表面覆盖呼吸道上皮,在免疫监视和调节中起着至关重要的作用,是抵御各种病原微生物、变应原和组织损伤的第一道防线.近年来,大量研究认为上皮源性细胞因子,如白细胞介素(IL)-25、IL-33和胸腺基质淋巴细胞生成素(...     

Analysis of postoperative hemorrhage after adenoidectomy and tonsillectomy in children in own material

Hypertophy of pharyngeal tonsil and palatine tonsils is the most common cause of nasal obstruction in children. When the obstruction of the nasopharynx causes recurrent infections of upper respiratory tract, chronic otitis media secretoria or sleep apnoea, then adenoidectomy with or without tonsillectomy is indicated. The purpose of the study was analysis of postoperative hemorrhage after adenoidectomy with or without tonsillectomy. The influent of frequent infections of upper respiratory tract, disorders of blood clotting, chronic diseases, seasons of the year, operation time and general anesthesia on postoperative hemorrhage was estimated. A group of 1184 children after adenoidectomy with or without tonsillectomy was studied. Postoperative hemorrhage occurred in 59 children (4.98%). Early bleeding was frequently occurred after adenotonsillectomy and late bleeding after adenoidectomy. There was relationship between the time of general anesthesia and incidences of postoperative bleeding. Food or inhalation allergy, recurrent infections of upper respiratory tract and male sex are risk factors of postoperative hemorrhage after adenoidectomy with or without tonsillectomy.     

Causes of tonsillar disease and frequency of tonsillectomy operations

OBJECTIVE: To characterize the factors that influence the frequency of tonsillectomy and adenoidectomy operations. DESIGN AND SETTING: Nationwide questionnaire. Analysis of patients undergoing tonsillectomy or adenoidectomy at Helsinki University Central Hospital, Helsinki, Finland. PARTICIPANTS: Four hundred eighty-three of 819 individuals randomly selected from the Finnish National Public Registry. Two thousand two hundred thirty-one individuals younger than 30 years who underwent tonsillectomy (888 patients), adenotonsillectomy (294 patients), or adenoidectomy (1049 patients) at Helsinki University Central Hospital from January 1, 1997, through December 31, 1998. MAIN OUTCOME MEASURES: Age of the individual at the time of operation. Indication for the operation. RESULTS: The frequency of adenoidectomies was 24% (116 persons) and that of tonsillectomies 8% (39 persons) among the 483 individuals who returned the questionnaire. The frequency of tonsillectomy operations by age was multimodal; the frequency of tonsillectomies increased in preschool-aged children, declined thereafter, and increased again in teenagers. Tonsillar hyperplasia was the most frequent among children younger than 10 years, peritonsillar abscesses among teenagers, and chronic tonsillitis among individuals older than 20 years. The proportion of females was higher than males among teenaged patients. However, the cause and sex distribution could not explain the multimodality in the age-specific frequency. The age-specific frequency of tonsillectomies performed because of peritonsillar abscesses still followed a multimodal distribution. CONCLUSIONS: Factors relating to respiratory tract infections, maturation of the immune system, and the onset of puberty contribute to the cause of tonsillar disease. Distinct indications for tonsillectomy should be defined for preschool-aged children, teenagers, and individuals older than 20 years.     

Why do palatine tonsils grow back after partial tonsillectomy in children?

Within the last decade, adenoidectomy with partial tonsillectomy has been revived in children with obstructive sleep-disordered breathing caused by adenotonsillar hyperplasia, generating debate about remaining tonsillar tissue regrowth. The study examined potential risk factors of the regrowth. Prospective, nonrandomised, case series feasibility study of children meeting the criteria for palatine tonsils regrowth after partial tonsillectomy performed in patients with obstructive sleep-related breathing disorder was carried out. Out of 793 operated children, 294 after adenoidectomy and 373 after adenotonsillotomy were followed up for 4 years in 12-month intervals. In 27 children after adenotonsillotomy, regrowth of tonsillar tissue was observed. In 22 individuals after adenoidectomy alone, hyperplasia of palatine tonsils was noted. The children had bacterial cultures of pharyngeal smears and blood samples tested for anti-streptolysin O, C-reactive protein and total IgE. Caregivers completed a questionnaire reporting on: their child’s breathing after surgery; frequency, severity and treatment of upper respiratory tract infections; diet; family history of adenoidal and/or tonsillar hyperplasia; and history of allergy. As controls, 272 participants after adenoidectomy alone and 346 after adenotonsillotomy were examined. The amount of sugar in the diet and the incidence of upper respiratory tract infections after surgery differed between the groups of patients and controls. Other differences were insignificant. The tonsillar tissue remaining after partial tonsillectomy in children has a remarkable tendency to grow back, related to a diet abundant in sugar and numerous upper respiratory tract infections. Tonsillar regrowth was age related and occurred most frequently in individuals older than 7 years.     

Nasal respiratory function and craniofacial growth

Nasal respiratory function and its relationship to growth development of the craniofacial structure has been a subject of interest and controversy for over 100 years. The otolaryngologist as the primary physician with responsibility of managing the upper respiratory tract is obviously most intimately involved with diagnosis and treatment of upper respiratory tract problems. To further evaluate the evidence regarding causes of craniofacial growth, a study was done involving pretreatment orthodontic subjects and their manifestation of classic signs of adenoid facies ("long-face syndrome"). Randomly selected were 106 subjects, ranging in age from 6 to 13 years, for evaluation of the facial features and medical history associated with long-face syndrome. No conclusive proof was found that nasal respiratory obstruction alters facial growth development. Studies of the nasal respiratory function need to be done utilizing clear definitions of respiratory mode and objective; reproducible techniques of measuring respiratory modes must be employed. Highly selected orthodontic patients can benefit from adenoidectomy and/or tonsillectomy.     

Analysis of hearing loss due to cis-diamminedichloroplatinum-II

Summary In order to establish an experimental model for the study of immunological reactions to exogenic immunogens in the upper and lower respiratory system NMRI mice were subjected to inhalation of the mitogenic and inflammatory response inducing lectin concanavalin A (Con A) and bovine serum albumin (BSA). Immunological reactions were induced in the upper respiratory tract and in the lungs. Serologically, the course of the antibody titre was measured by radio-immunoassay over several weeks. Germinal centre reactions in the nose and paranasal sinus equivalents were the morphological correlate. The lungs showed an increase in the number of macrophages and a thickening of the alveolocapillary membrane, but no germinal centre reactions were observed. These morphological and serological results may indicate a priming of the immune response in the upper respiratory tract leading to a subsequent production of antibodies in the lung.     

阻塞性睡眠呼吸暂停低通气综合征患儿扁桃体腺样体切除术后机体免疫功能的变化

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿进行扁桃体腺样体切除术后机体免疫功能的变化。方法:检测OSAHS患儿扁桃体腺样体切除术前后血清免疫球蛋白IgG、IgA、IgM及CD3、CD4、CD8的水平,比较患儿术前和术后不同时期血清免疫球蛋白和T淋巴细胞亚群的变化。结果:患儿术后IgG、IgA、IgM及CD3、CD4、CD8的水平有所下降,但与术前相比差异无统计学意义。结论:OSAHS患儿进行扁桃体腺样体切除术对细胞免疫和体液免疫影响不大。儿童时期切除扁桃体和腺样体并不损害宿主免疫的完整性或减少宿主的免疫活力。