儿童腺样体肥大110例分析

近几年，由于儿童分泌性中耳炎、鼻窦炎、睡眠打鼾的病例逐渐增多，腺样体肥大引起的危害性引起了人们重视。我科3年来收治腺样体肥大患儿110例，并进行了手术治疗，效果满意，报告如下。     

儿童腺样体肥大与分泌性中耳炎病因的关系探讨

目的 探讨腺样体肥大与儿童分泌性中耳炎（SOM）病因的关系,提高对两者关联性疾病的认识。方法 回顾分析诊断有分泌性中耳炎、腺样体肥大、慢性扁桃体炎、小儿鼾症或阻塞性睡眠呼吸暂停综合征的住院儿童742例的资料,进行统计分析。结果 742例中有173例SOM,SOM中伴腺样体肥大的有65例,而腺样体肥大(包括伴有SOM)有570例,腺样体肥大中发生SOM的机率为11.40%。结论 单纯腺样体肥大不是引起SOM的主要因素,儿童SOM是多种因素综合导致的结果。     

儿童OSAHS与腺样体和扁桃体大小的关系探讨

目的：探讨儿童OSAHS与腺样体、扁桃体大小的关系。方法：2008—06—2010—10期间在我科门诊和病房以PSG确诊的338例OSAHS患儿为病例组,并根据阻塞性呼吸暂停指数（0AI）或AHl分为轻、中、重3个亚组,同时采用简单随机抽样方法,选择同期就诊的无上呼吸道阻塞症状的207例声带小结患儿为对照组。对2组患儿口咽部、电子鼻咽喉镜的检查结果,进行回顾性分析,探讨腺样体、扁桃体大小与儿童OSAHS的相关性。以SPSS17．0软件对数据进行统计学分析。结果：病例组Ⅲ、Ⅳ度腺样体以及Ⅲ、Ⅳ度扁桃体的比例分别为89．7％、68．4％,明显高于对照组的30．9％、13．5％,差异有统计学意义（均P〈0．01）。病例组中,Ⅳ度与Ⅲ度腺样体比较,Ⅳ度与Ⅲ度扁桃体比较,前者发生OSAHs的危险程度明显增高。腺样体、扁桃体分度的比例在病例组轻、中、重亚组中逐级递增（P〈0．01）。采用张口压舌法与电子鼻咽喉镜检查,对多数病例组患儿扁桃体大小和咽腔狭窄的判断结果一致。但35例张口压舌法检查为I、Ⅱ度的扁桃体,其中13例（37．1％）以电子鼻咽喉镜检查扁桃体为Ⅲ度。结论：腺样体肥大、扁桃体肥大是儿童OSAHS的危险因素,其中Ⅳ度腺样体和Ⅳ扁桃体的发病风险明显增高;腺样体、扁桃体大小与儿童OSAHS的病情严重程度呈正相关;电子鼻咽喉镜检查是儿童OSAHS病因诊断的重要检查手段,且有助于包埋型扁桃体大小的判断。     

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。     

儿童腺样体检测在上呼吸道疾病外科中的临床意义

分泌性中耳炎、急慢性鼻窦炎、阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是儿童较为常见的疾病。而腺样体与扁桃体一样作为人体内免疫器官，在儿童时期由于生长发育以及炎症的刺激，容易引起腺样体肥大，从而引起相邻器官产生病变，导致生理功能异常。     

EB病毒与儿童扁桃体腺样体肥大的相关研究现状

咽淋巴环位于气道和消化道的入口处,是人体抵御病原体的第一道防线.扁桃体和腺样体是咽淋巴环内环的重要组成部分,许多微生物可以通过反复感染引起腺样体和扁桃体淋巴组织增生[1].扁桃体和腺样体肥大会引起阻塞性睡眠呼吸暂停低通气综合征(OSAHS)、打鼾[2]、中耳炎、鼻窦炎[3-4]、颌面部发育异常[5]等并发症,因此,扁桃...     

纤维鼻咽镜引导下儿童肥大腺样体刮除86例临床观察

腺样体肥大是儿童常见病，常与扁桃体肥大合并存在，是引起儿童分泌性中耳炎，阻塞性睡眠呼吸暂停的主要原因。长期不治还可导致颌面发育障碍及身体生长发育迟缓。因此，一经确诊，应尽早手术。2000年1月～2004年1月，我科在纤维鼻咽镜引导下治疗儿童肥大腺样体86例，疗效满意。现报告如下。     

儿童腺样体肥大的两种手术方法疗效比较分析

腺样体肥大是儿童常见的疾病之一，是引起儿童分泌性中耳炎、鼻窦炎和儿童阻塞性睡眠呼吸暂停低通气综合征的主要病因，长期不治还可导致颌面发育障碍，影响儿童的生长发育及听力损害，因此，一经确诊应尽早施行腺样体切除术。我科自2002年2月-2005年10月采用鼻内镜辅助经口腔直视下切除腺样体（ETA）的术式，观察术后症状及体征的变化，并与传统的经口腔刮除术（TCA）作比较，探讨两种术式的优缺点。     

腺样体肥大儿童伴变应性鼻炎与分泌性中耳炎的相关性分析

目的 分析腺样体肥大儿童伴分泌性中耳炎(ＯＭＥ)与变应性鼻炎(ＡＲ)发病的相关性。方法 回顾性分析12岁以下870例腺样体肥大患儿的病史,分析AR、咽鼓管功能不良及OME的相关性。结果 本组腺样体肥大患儿中AR发病率为30.11%,AR在不同年龄组中的发病率差异有统计学意义,随着年龄增加,发病率逐渐升高(P<0.01)。6岁以内发生咽鼓管功能障碍及OME的概率高,其中1~3岁组发生分泌性中耳炎的概率最大(P<0.01)。春季OME发病率高(P<0.001)。与不伴AR患者相比,伴有AR患儿患咽鼓管功能不良的概率增加了0.4倍(P=0.042);但患有OME的检出率减少了32%(P=0.0472)。结论 在腺样体肥大患儿中,多种因素使咽鼓管功能不良乃至OME高发。其中咽鼓管及其周围结构生理、病理、发育特点是最主要的因素,变态反应是次要影响因素。随着年龄增长,前者因逐渐发育完善,致病性降低,后者致病性增高,但总的发病率是逐渐降低的。     

儿童腺样体肥大和变应性鼻炎关系的临床研究

目的探讨儿童腺样体肥大与合并变应性鼻炎的相关性。方法抽选2017年10月至2018年10月间收治的60例儿童腺样体肥大患者,均对患儿进行鼻咽侧位像DR扫描,测定腺样体/鼻咽腔比率(A/N比值)来评定腺样体的大小,采用视觉模拟量表(VAS) 供患者对疾病程度和生活质量所受的影响程度进行自我评估,依据症状发作的频度,持续时间,对睡眠、学习及工作的影响程度评分。应用Spearman秩相关对二者相关性进行分析。结果 60例腺样体肥大患儿中,合并变应性鼻炎20例,占33.3%。腺样体肥大1级患儿4例,视觉模拟量表(VAS)评分为1-4分;2级6例,视觉模拟量表(VAS)评分2-7分;3级10例,视觉模拟量表(VAS)评分4-10分。腺样体肥大等级越高,视觉模拟量表(VAS)评分也越高。腺样体肥大与合并变应性鼻炎呈正相关。结论儿童腺样体肥大和变应性鼻炎具有显著相关性,腺样体肥大也是造成变应性鼻炎患病的因素之一。儿童变应性鼻炎的临床治疗,明确主要病因与腺样体肥大有关时,可采用对腺样体肥大的专业治疗,可有效消除变应性鼻炎的病源,改善患儿变应性鼻炎的症状,提升患儿的生活质量。     

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.     

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。     

腺样体肥大3种不同手术方式的比较

目的:比较经鼻内镜腺样体切除术(TEA)、内镜辅助经口腺样体切除术(ETA)及传统的经口腔腺样体刮除术(TCA)的优缺点。方法:分析130例接受腺样体肥大手术患者的临床资料,比较3种术式的术后听力、夜间打鼾、鼻塞、鼻漏等症状恢复和腺样体残留等情况。结果:术后随访6~44个月,平均21.4个月。TCA术后鼻塞改善有效率显著低于ETA(P<0.05)。TCA术式中,有20例患者存在腺样体残留,其他两种术式无腺样体残留。结论:腺样体肥大的最佳手术方法为ETA,伴有鼻腔、鼻窦疾病者可行TEA。     

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。     

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.     

Association of asymptomatic otitis media with effusion in patients with adenoid hypertrophy

ObjectiveClinical symptoms of otitis media with effusion are rarely brought forward to the guardians of young children who the disease is most prevalent in. This often leads to poor scholastic performances and difficult social interactions. The objective of this study was to identify asymptomatic cases of otitis media with effusion present in individuals with adenoid hypertrophy.Material and MethodsIn a cross sectional study advocated in Justice K.S.Hegde Hospital, Karnataka India we evaluated one hundred patients above the age of three from August 2016 to December 2017. Candidates who presented with an adenoid nasopharyngeal ratio of more than 0.5 were selected for the study. Individuals who complained of otological symptoms were not considered for the study. Patients cleared of other pathological otological conditions were underwent audiological evaluation with pure tone audiometry and tympanometry for evaluating the middle ear status and hearing loss.ResultsThe study showed a total of 36% of patients evaluated presented with asymptomatic otitis media with effusion. In candidates who presented with a bilateral B tympanogram, 40% had significant conductive hearing loss of more than 25dB.ConclusionAn objective test such as impedance audiometry in all patients with adenoid hypertrophy would aid in the diagnosis of fluid in the middle ear, so that timely intervention can be done and possible complications be averted.     

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...