儿童扁桃体、腺样体低温等离子切除术后出血的临床研究

目的 探讨应用低温等离子手术或者传统手术方式行儿童扁桃体、腺样体切除术在术后出血方面存在的差异。方法 回顾性分析1597例接受手术治疗的儿童慢性扁桃体炎、腺样体肥大的患者资料,行等离子射频辅助的扁桃体和(或)腺样体切除术者793例(等离子组),行传统扁桃体切除和(或)腺样体者804例(传统组)。比较两组原发性及继发性出血的发生率、出血程度和出血部位的差异。结果 等离子组发生术后出血25例(3.2％),传统组出血19例(2.4％),两组间差异无统计学意义(χ2=3．34,P>0．05);其中等离子组原发性出血9例(1.1％),继发性出血16例(2.0％);传统组原发性出血11例(1.4％),继发性出血8例(1．0％),两者比较差异有统计学意义(χ2=9．45,P<0．01)。两组术后的出血部位经卡方检验,出血程度经Wilcoxon秩和检验,P值均>0．05,差异均无统计学意义。结论 低温等离子辅助行儿童扁桃体、腺样体切除术,在术后出血的发生率、程度、部位三个方面相对于传统的手术方法治疗,二者差异无统计学意义。     

儿童扁桃体与腺样体切除术后发热因素分析

目的 探讨儿童扁桃体和/或腺样体切除术后发热的相关因素,为手术治疗和护理提供参考.方法 收集408例因扁桃体和/或腺样体肥大引起阻塞性睡眠呼吸障碍(OSDB)行扁桃体和/或腺样体切除术患儿的相关资料,分析发热与术中出血量、性别、扁桃体腺样体大小、扁桃体炎史、鼻窦炎现状、手术时段、手术季节和手术部位的关系.结果 408例...     

儿童扁桃体切除术后出血率及出血程度分级的初步探讨

目的　统计儿童扁桃体切除术后出血率,根据Windfuhr分级法衡量儿童扁桃体术后出血的程度。方法 统计2010年3月～2013年3月在深圳市儿童医院行扁桃体切 除或扁桃体加腺样体切除患儿资料,统计术后出血发生率。结果　1672例患儿扁桃体切除术后出血16例,出血率为0.96%。女童术后出血率1.8%明显高于男童出血率0.53%,差异有统计学意义（χ 2=5.545,P <0.05）;原发性出血6例,继发性出血10例。出血程度1级9例,2级7例。结论 儿童扁桃体切除术后出血率很低,遇有活动性出血者应手气管插管全麻下止血。     

345例腺样体肥大患儿细菌学相关性分析

目的　研究腺样体肥大儿童的鼻咽部细菌学特点。方法　选取住院手术的345例腺样体肥大患儿,术中留取腺样体表面分泌物及腺样体实体组织标本,行细菌培养及药敏试验,根据细菌培养条件致病菌检出情况,比较患儿在性别、年龄、孕周、喂养方式等多个相关因素间的差异,并分析其药敏特点。结果　腺样体肥大患儿中条件致病菌检出率为29.86%（103/345）,以流感嗜血杆菌为主,其 次为金黄色葡萄球菌和肺炎链球菌。伴鼻窦炎患儿条件致病菌检出率高于不伴鼻窦炎患儿（χ2=5.729,P =0.022）;伴扁桃体肥大患儿条件致病菌检出率高于不伴扁桃体肥大患儿（χ2=6.231,P =0.013）;腺样体Ⅲ度患儿条件致病菌检出率高于腺样体Ⅳ度患儿（χ2=6.518,P =0.011）。在性别、年龄、孕周、喂养方式、家庭宠物、生活环境、病史长短等方面各组无显着性差异（P >0.05）。以上常见细菌对β-内酰胺酶抑制剂复合药物、喹诺酮类抗生素较敏感,对非β-内酰胺酶抑制剂和磺胺类药物耐药明显。结论　流感嗜血杆菌、金黄色葡萄球菌和肺炎链球菌是儿童腺样体肥大的菌群分布中3种主要的条件致病菌。鼻窦炎、扁桃体肥大及腺 样体分度是影响儿童腺样体肥大菌群的重要因素。腺样体相关疾病诊治中,头孢类抗生素仍是用药首选,但二代头孢中的头孢呋辛耐药明显,为不推荐用药。     

低温等离子刀扁桃体腺样体切除术后出血原因及预防的探讨

目的探讨应用低温等离子刀行儿童扁桃体及腺样体切除术后出血的原因及预防。方法回顾分析2010年11月～2013年2月188例患儿应用低温等离子刀行扁桃体及腺样体切除术,年龄19个月～12岁,平均（5.3±3.1）岁,其中单纯行扁桃体切除60例,同时行扁桃体及腺样体切除69例,单纯行腺样体切除59例。结果 4例发生术后出血,其中3例为术后7～10 d,1例为术后24 h内,均为扁桃体切除术后出血,无腺样体切除术后出血病例。结论患儿自身因素及术者的操作水平是导致术后出血的重要原因,术前及术后宣教及护理、术中充分止血及较高的手术技巧是减少术后出血的关键。     

腺样体与咽鼓管圆枕的毗邻关系及其与分泌性中耳炎的相关性

目的　观察腺样体肥大儿童的腺样体与咽鼓管圆枕的毗邻关系,探讨其与分泌性中耳炎的相关性。方法 144例腺样体肥大（或同时扁桃体肥大）70°鼻内镜下行等离子消融术患儿,术中观察并记录腺样体与咽鼓管圆枕的毗邻关系,并将其分为Ⅰ、Ⅱ、Ⅲ共3型;比较3组患儿分泌性中耳炎发病率、腺样体重度肥大（A/N比值是否大于0.7） 的发生率并计算有无统计学差异。结果　本组患儿分泌性中耳炎发病率23.6%;腺样体与咽鼓管圆枕的毗邻关系及合并分泌性中耳炎,Ⅰ型3例（9.1%,3/33）、Ⅱ型10例（16.9%,10/59）、Ⅲ型21例（40.4%,21/52）,Ⅰ型与Ⅱ型分泌性中耳炎发生率无显著性差异（χ 2=1.077,P =0.299）,Ⅰ型与Ⅲ型有显著性差异（χ 2=9.757,P =0.002）,Ⅱ型与Ⅲ型有显著性差异（χ 2 =7.542,P =0.006）;Ⅰ型和Ⅱ型组腺样体A/N＞0.7之和为34.9%,三型组A/N＞0.7为82.2%,Ⅰ型及Ⅱ型腺样体重度肥大率之和与Ⅲ型有显著性差异（χ 2=30.556,P =0.000）。结论　腺样体与咽鼓管圆枕毗邻关系及腺样体的肥大程度与分泌性中耳炎有显著相关性。     

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。     

复发性腺样体扁桃体炎儿童腺样体与扁桃体的细菌学研究

为探讨儿童腺样体扁桃体炎反复发作的原因及腺样体与扁桃体的细菌分布情况 ,对 2 5例反复发生 A族乙型溶血性链球菌感染的腺样体扁桃体炎儿童切除的扁桃体和腺样体进行细菌学研究。其中男 14例 ,女 11例 ,病史 10个月～ 3年 ,每年至少发作 5次 ,至少于术前 1个月未接受抗生素治疗。将切除后的标本 (每例各取 1个扁桃体及腺样体 )立即接种于培养基上进行有氧及厌氧菌培养。结果 :从扁桃体中分离出 2 2 4株细菌(112株需氧菌与兼性菌 ,110株厌氧菌 ,2株白色念珠菌 ) ,从腺样体中分离出 2 2 9株细菌 (111株需氧菌与兼性菌 ,118株厌氧菌 ) ,所有…     

儿童扁桃体腺样体切除术对嗓音影响的研究

目的通过评估儿童扁桃体腺样体切除术前后的嗓音特性,为建立更合理的扁桃体腺样体肥大的管理和治疗手段提供帮助。方法评估4～14岁儿童扁桃体腺样体切除术20例。手术前后分别采用多维嗓音分析（Multi-Dimensional Voice Program,MDVP,KayElemetrics）软件做嗓音评估。结果扁桃体腺样体切除术后,所有嗓音参数与术前相比均有改变,其中基频、清浊率、嗓音骚动指数等参数术后与术前相比变化明显。结论术后嗓音参数变化客观的说明扁桃体腺样体切除术改变了共鸣腔的结构,影响了嗓音的质量。而MDVP可为分析嗓音、评估扁桃体腺样体切除术后嗓音的预后提供客观手段。     

扁桃体和腺样体肥大患儿心理行为特征的对照研究

目的：扁桃体和腺样体肥大对儿童心理行为的影响。方法：采用湖南医科大学龚耀先1986年修订的Achenbach儿童行为量表对97例扁桃体和腺样体肥大患儿进行心理行为的检测。结果：扁桃体和腺样体肥大儿童心理行为异常检出率明显高于对照组。扁桃体和腺样体肥大患儿心理行为的总粗分均显著高于对照组,差异有统计学意义（P〈0．01）。男孩主要表现在分裂性、交往不良、强迫性、多动、违纪方面,女孩主要表现在体诉、多动、攻击方面,均差异有统计学意义（均P％0．01）。行扁桃体切除术和腺样体切除术3个月后,对患儿进行第2次测试,术后男孩在分裂性、抑郁、强迫性、体诉方面分数及总粗分明显低于术前值,差异有统计学意义（P〈0．05）。女孩在抑郁,强迫分裂性、违纪、攻击、残忍方面分数及总粗分明显低于术前值,差异有统计学意义（P〈0．05）。心理行为异常检出率与患儿年龄呈正相关。结论：扁桃体和腺样体肥大对患儿的心理行为有比较明显的影响,应加强对扁桃体和腺样体肥大患儿的心理行为干预。     

Adenoids and tonsils, indications for surgery and immunological consequences of surgery

Tonsillectomy and adenoidectomy procedures are among the oldest surgical procedures still performed today. Tonsils and adenoids are part of Waldeyer's ring, the basic function of which is antibody formation. Because of their location at the portal of entry of many airborne and alimentary antigens, the tonsils and adenoids often have been considered as the first line of defense against respiratory infections. Indications for adenoidectomy or tonsillectomy are to date still controversial. The two main indications for tonsillectomy are upper airway obstruction due to tonsillar hypertrophy and recurrent acute or chronic tonsillitis. Adenoid hypertrophy with upper airway or eustachian tube obstruction and recurrent acute or chronic adenoiditis or otitis media are main indications to perform an adenoidectomy. The possible immunological effects of tonsillectomy and adenoidectomy are still controversial. Some authors have found changes in immunoglobulin levels after tonsillectomy, while others failed to find significant changes. In a review of long-term follow-up studies, the authors showed that while tonsillectomy may lead to certain changes in the cellular and humoral immune system, these alterations are clinically insignificant and no increased frequency of immunomodulated diseases should be expected.     

Wertigkeit der Anamnese bei der Indikationsstellung zur Tonsillotomie

Background

In pre-school children suffering from pure non-inflammatory hyperplasia of the tonsils, tonsillotomy has recently been recommended in preference to tonsillectomy. Absence of inflammatory tonsillitis in the previous medical history is accepted as evidence that tonsillotomy is indicated. In this study, we therefore examine whether and to what degree the medical history correlates with the histological findings.

Patients and Method

In a prospective study 59 children admitted to our department for tonsillectomy were each allocated to one of three groups according to how many episodes of acute tonsillitis they had been suffering from per year prior to admission: group 1 0 episodes of tonsillitis/year; group 2 1 or 2 episodes/year; group 3 >2 episodes/year. These groups were then compared with the diagnoses yielded by histological examination of the excised tonsils, which were classified into (1) pure hyperplasia; (2) chronic inflammatory tonsillitis; (3) hyperplasia and chronic inflammatory hyperplasia; and (4) chronic inflammation with peritonsillar scarring.

Results

In group 1 (n=23) pure hyperplasia was found in only 2 cases, while the tonsils of all other children were affected by chronic inflammatory tissue changes, either alone or in association with hyperplasia. In groups 2 und 3 most tonsillar specimens showed histological characteristics of chronic inflammation, but non-inflammatory hyperplasia alone was also found in 5 cases.

Conclusion

There is no correlation between the medical history of children undergoing tonsillectomy and the histological diagnosis. In other words, the medical history does not appear to be an appropriate way of reaching a differential diagnosis between non-inflammatory hyperplasia and chronic tonsillitis. This means that tonsillotomy may well leave remnants of chronically inflamed tonsillar tissue in place. Appropriate counselling of the parents seems to be necessary.     

Microbiology of the tonsils and adenoids in a pediatric population

To investigate the microbial flora of the tonsils and adenoids, the core tissue from the tonsils and adenoids of 50 children undergoing tonsillectomy and adenoidectomy for either recurrent infection or airway obstruction was cultured aerobically and anaerobically, and the number of bacterial colonies was quantitated. The most common organisms isolated were alpha-hemolytic streptococci, nonpathogenic Neisseria species, Haemophilus species, Staphylococcus aureus, and Corynebacterium species. No anaerobes were identified. Bacterial isolates from the tonsils and adenoids were similar in number and frequency of occurrence. Potential pathogenic bacteria (Haemophilus species, S aureus, beta-hemolytic streptococci, and Streptococcus pneumoniae) were identified in 40 patients. Seventy-three percent of these patients shared a common pathogen in tonsil and adenoid tissue. Haemophilus species were recovered in 54% of patients and S aureus in 46%. No significant difference exists between the type and number of pathogens in patients undergoing adenotonsillectomy for recurrent infection or obstruction.     

Enzymatic study of tonsil tissue alkaline and acid phosphatase in children with recurrent tonsillitis and tonsil hypertrophy

Objective

Indications for tonsillectomy in recurrent tonsillitis are defined according to the number of episodes of acute bacterial infections in a year. However, little is known about the tonsil immune competence status in patients presenting with recurrent tonsillitis with either hypertrophied or atrophied tonsils, or in patients presenting with obstructive sleep apnoea. In this study we examined the tonsil immune status in children with 3-5 acute recurrent infections a year and in children with obstructive sleep apnoea by comparing the activity of tonsil and adenoid tissue nonspecific alkaline and acid phosphatase.

Methods

Specific activity of tonsil and adenoid tissue nonspecific alkaline and acid phosphatase was investigated in children who underwent tonsillectomy and adenoidectomy for recurrent infection (72 children) and for obstructive sleep apnoea (10 children). Tissue enzyme activities were measured using p-nitrophenylphosphate as a substrate. Tissue samples were examined by the haematoxylin-eosin histological technique. Statistical analyses were performed using SPSS v. 16 software.

Results

The tissue nonspecific alkaline phosphatase activity was similar in hypertrophied tonsils in the recurrent infection group and in the obstructive sleep apnoea group (3.437 ± 1.226 and 3.978 ± 0.762 U/mg of protein, respectively). The enzyme activity in both hypertrophied tonsil groups was significantly higher as compared to atrophied tonsils in the recurrent tonsillitis group, p = 0.021 and p = 0.006, respectively. The enzyme activity was significantly higher in the adenoids compared to the tonsils from all three groups. Contrary to this, no significant differences were noticed for tonsil and adenoid acid phosphatase activities among the groups.

Conclusion

Similar acid phosphatase activity in all three groups implies that all three groups have preserved antigen presenting cell activity. In patients with hypertrophied tonsils similar tissue nonspecific alkaline phosphatase activity suggests preserved B cell tonsil immune activity, regardless of the pathology. Patients with atrophied tonsils had significantly lower alkaline phosphatase activity, indicating relative tonsil B cell immune deficiency. Thus, different immunological status in patients presenting with hypertrophied vs. atrophied tonsils could point to a different underlying pathophysiologic mechanism of the disease.     

低温等离子射频扁桃体部分切除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征

目的:探讨低温等离子射频扁桃体部分切除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的可行性并观察疗效。方法:回顾性分析91例OSAHS患儿的临床资料,所有患儿无反复咽痛及扁桃体炎表现,主要阻塞病变为扁桃体及腺样体肥大,应用低温等离子射频行扁桃体部分切除术及腺样体消融术治疗。结果:术中出血1～2ml,无原发及继发性出血,术后疼痛轻微。随访12～22个月,所有患儿睡眠打鼾及张口呼吸均消失,无扁桃体再生及反复炎症发作。结论:低温等离子射频切除部分扁桃体治疗儿童OSAHS微创、安全、有效,适用于各年龄段的扁桃体为增生肥大病变的患儿,是一种较好的儿童OSAHS治疗方法。     

New indication for adenoidectomy-tonsillectomy in children: elimination of obstruction in obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) in children produces serious organic consequences that affect pharyngeal breathing and functional development. The high rate of incidence of this problem is important. In children, the most frequent cause of OSAS is hypertrophy of the tonsils, adenoids, or both. We think that a new indication for pediatric adenoidectomy and tonsillectomy is pharyngeal breathing obstruction by hypertrophic lymphoid formations in the Waldeyer ring. In a statistical analysis of 180 children with OSAS who underwent tonsillectomy and adenoidectomy, the disappearance of most symptoms 7 months after surgery was significant.     

A comparison of tonsillar size and oropharyngeal dimensions in children with obstructive adenotonsillar hypertrophy

Hypertrophy of the tonsils and adenoids is the most common cause of obstructive sleep apnea in children. There is relatively little known about the occurrence of subclinical variations in the dimensions of the oropharynx which may predispose to the development of obstructive sleep apnea in children without obvious craniofacial abnormalities. Fifty-one children (3-10 years) were divided into two groups: the first group consisted of 18 patients with small tonsils and no history of snoring who underwent tonsillectomy for chronic tonsillitis. They were compared to a second group of 33 patients with large tonsils who underwent tonsillectomy and adenoidectomy for symptoms of obstructive sleep apnea. Age, height, weight, body surface area and tonsil weight were correlated to the dimensions of the oropharynx obtained by direct measurement intraoperatively including the length of the soft palate, anterior-posterior depth of the nasopharynx and the distances between the medial tonsillar surfaces, anterior tonsillar pillars and lateral pharyngeal walls at mid-tonsil level. Increased patient height, weight and surface area correlated positively to increased distance between the lateral pharyngeal walls and to the length of the soft palate in the patients with small tonsils. No such correlation existed in the patients with obstructive adenotonsillar hypertrophy. In addition, the distance between the lateral pharyngeal walls was significantly decreased in the group with large, obstructing tonsils as compared to those with small tonsils and no history of obstruction (P less than 0.01). However, the patients with small tonsils and no obstruction had significantly longer soft plates (P less than 0.01) and less depth tot eh nasopharynx (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of the surface and core bacteria in tonsillar and adenoid tissue with Beta-lactamase production

Adenoidectomy and tonsillectomy, indicated for children with recurrent or persistent symptoms of infection or hypertrophy, are among the most frequent operations performed in children. This study was carried out for investigating the microbial flora of the tonsils and adenoids regarding to core and surface microorganisms and also pathogen microrganisms' beta-lactamase production rate. Cultures were taken from the core and surface of tonsils and adenoids of the 91 patients at the time of the surgery for tonsillectomy and adenoidectomy. Aerobic and anaerobic cultures were inoculated and identified. Beta-lactamase production was detected also. The most frequently isolated aerobic microorganisms were Streptococcus viridans and Neisseria spp. The number of the microorganisms isolated from the tonsil core compared to the surface of the tonsils was found statistically insignificant (P?>?0.05). The number of the adenoid surface aerobic microorganisms was found higher from the adenoid core (P??0.05). The togetherness of Staphylococcus aureus and other beta-lactamase producing bacteria was found statistically significant (P?相似文献   

Is adenotonsillectomy safe in covid-19 era? Investigation of sars-cov2 in adenoid and tonsil tissues

ObjectivesCOVID-19 has seriously altered physicians' approach to patients and diseases, with a tendency to postpone elective procedures. Tonsillectomy, alone or with adenoidectomy, is one of the most common surgeries performed by otolaryngologists. Although they are generally accepted as elective surgeries, they significantly improve the quality of life, and postponing these surgeries for a long time can have deteriorative effects on the patients. We aimed to investigate the presence of SARS CoV-2 in the adenotonsillectomy materials to find out if performing adenotonsillectomy is safe during the COVID-19 pandemic.MethodsForty-eight tissue samples from 32 patients that underwent tonsillectomy with or without adenoidectomy were investigated whose SARS-CoV-2 RT-PCR test in the samples obtained from nasopharyngeal (NP) and oropharyngeal (OP) swabs were negative within 24 h before the operation. While 16 patients underwent only tonsillectomy and one of their tonsils was investigated, 16 of the patients underwent adenotonsillectomy and their adenoid tissues were sent along with one of their tonsils. SARS-CoV-2 viral RNA was investigated with Real-Time PCR in tissue samples.ResultsTwo (4.2%) tissue samples had positive PCR tests for SARS-CoV-2, while 46 of them were negative. One of the positive patients had undergone tonsillectomy with the indication of chronic recurrent tonsillitis, and the other patient had undergone adenotonsillectomy for obstructive adenotonsillar hypertrophy. PCR test was positive in the adenoidectomy specimen and negative in the tonsillectomy specimen in this patient.ConclusionsAdenotonsillectomy can be done safely in asymptomatic patients without a history of Covid-19, with a negative PCR test result obtained within the last 24 h.