手术治疗腺样体肥大对儿童睡眠结构的影响

目的 观察腺样体肥大儿童在行腺样体切除术后睡眠结构的改变。方法 对120例行腺样体肥大切除术的儿童,分别于术前及术后1个月行夜间睡眠多导监测,比较手术前后宏观、微观睡眠结构的变化。结果 腺样体肥大儿童术后S1期和S2期所占比例与术前比较无统计学意义(P>0.05);SWS期和REM期所占比例增加(P>0.05)。腺样体肥大儿童术后觉醒指数AI(2.8±0.3)较术前(6.3±0.4)明显减小(P<0.01);术后最低SaO2（93.4±1.4）较术前(70.3±1.3) 明显提高(P<0.01)。 结论 腺样体肥大儿童术后宏观睡眠结构无明显改善,微观睡眠结构的改善可能是腺样体肥大儿童术后症状改善的病理生理学基础。     

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。     

儿童腺样体肥大再次手术的观察

传统的腺样体刮除术是在盲视下采用腺样体刮匙刮除,手术带有盲目性,加上手术器械本身的局限性及手术者的技术水平,术后易残留致复发,复发率高,常需再次手术治疗。我科自2004年1月以来,采用鼻内镜及XPS动力吸割系统,在电视显示系统监视下行腺样体吸割术治疗儿童腺样体肥大,取得了良好的疗效。在此诊治过程中,我们发现有部分患儿曾经接受过传统的腺样体刮除术,因术后症状复发而需再次手术。我们对20例再次手术患儿的复发原因进行了分析,报告如下。     

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。     

经鼻内窥镜行儿童腺样体肥大切割术的体会

腺样体肥大是儿童常见病 ,是引起儿童分泌性中耳炎、鼻窦炎、阻塞性睡眠呼吸暂停综合征的主要病因 ,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 ,应尽早施行腺样体切除术〔1〕。 1 999年 1 2月～ 2 0 0 0年 1 2月我科应用鼻内窥镜技术行经鼻和口腺样体切割术治疗儿童腺样体肥大 2 7例 ,现总结如下。1 　 资料与方法1 .1 　 临床资料本组 2 7例 ,男 1 9例 ,女 8例 ;年龄 5～ 1 2岁 ,平均 8.4岁。其中以鼻塞、多脓涕首诊者 1 2例 ,以睡眠打鼾者 5例 ,以听力下降者 1 0例。全部病例在本次治疗前均在本院或外院接受过保守治…     

儿童腺样体肥大手术疗效分析

目的 比较内镜辅助经口腺样体吸切术(ETA)和传统的经口腔腺样体刮除术(TCA)的优缺点.方法 将资料完整的148例儿童腺样体肥大患者随机分为内镜辅助经口腔腺样体吸切术组78例(ETA组)和常规腺样体刮除术组70例(TCA组),随访6～12个月,并进行回顾性分析.结果 ETA组术后腺样体切割干净,无残留,鼻咽部结构显示良好,患者症状消失或明显减轻.TCA组术后有25例残留.结论 内镜辅助经口腺样体吸切术术野清晰,可增加手术的安全性和准确性,提高疗效,减少并发症.     

儿童腺样体肥大不同术式体会

我科自2004年4月-2007年5月收治腺样体肥大患儿120例,分别采用腺样体刮除术、鼻内镜下腺样体微波消融术、鼻内镜下腺样体切割术、耳内镜下经口腺样体切除术各30例。比较4组患儿临床资料如下。     

中西医治疗儿童腺样体肥大研究新进展

腺样体(咽扁桃体亦或是增殖体)好发于鼻咽顶后壁衔接处的淋巴组织,一般情况下,该病在儿童出生时就存在,当生长至6～7岁症状明显,而10岁会缓慢萎缩,直至彻底性消失。如若其毗邻器官(鼻部、咽喉部等)长期处于炎症状态,则会增加腺样体的萎缩,进而诱发腺样体病理性肥大,对儿童生命产生严重威胁。西药治疗虽有一定效果,但其副作用较多,需找寻其他治疗方法。文章综述近年来中西医于儿童腺样体肥大中的治疗进展,旨在为临床提供更好的诊疗方案,提高患儿疗效。     

鼻内镜下微波治疗儿童腺样体肥大

自 1999年 2月～ 2 0 0 0年 8月 ,本科对 30例儿童腺样体肥大患者 ,在鼻内镜下 ,利用微波热凝原理进行治疗 ,效果满意 ,现报道如下。1　临床资料与方法30例患者中 ,男 2 4例 ,女 6例。年龄 5～ 13岁 ,平均 8.7岁 ,病程 2～ 7年 ,其中合并分泌性中耳炎 7例 (12耳 ) ,慢性扁桃体炎 2 2例 ,慢性鼻窦炎 8例。全部病例均作纯音测听加声导抗检查、鼻镜检查、咽腔检查及鼻内镜检查。 3例有腺样体面容 ;7例合并分泌性中耳炎患者 ,鼓室压图均为Ｂ型 ,纯音测听听力损失 16～2 5ｄＢ ;2 2例合并慢性扁桃体炎者 ,其中两侧扁桃体Ⅲ°12例。8例鼻镜检查 ,…     

儿童腺样体肥大3种切除方式疗效分析

目的：比较传统经口腔腺样体刮除术、鼻内镜下经鼻腔腺样体切除术及鼻内镜下经口鼻腔双径路腺样体切除术的疗效。方法：回顾性分析202例接受腺样体肥大手术患儿的临床资料,比较3种术式术后患儿夜间打鼾、鼻塞、鼻漏及听力等症状的恢复和腺样体残留等情况。结果：传统经口腔腺样体刮除术后6例患儿存在腺样体残留,其他2种术式术后无腺样体残留。鼻内镜下经口鼻腔双径路腺样体切除术后患儿打鼾、鼻塞症状改善明显。结论：腺样体肥大的理想手术方法为鼻内镜下经口鼻腔双径路腺样体切除术。     

Nasal nitric oxide in children with adenoidal hypertrophy: A preliminary study

Objective

Nasal nitric oxide, a mediator involved in upper airway inflammation, is impaired in children with allergic rhinitis and rhinosinusitis. Normal values are 200-450 parts per billion, but no data are available concerning its levels in children with adenoidal obstruction, predisposing to chronic nasosinusal inflammation. This study aimed to: (1) measure nasal nitric oxide levels in non-allergic children with adenoidal hypertrophy and (2) assess its possible relationship with the degree of adenoidal hypertrophy and other variable (gender, age, body max index, passive smoking exposure, recurrent acute otitis media, recurrent respiratory infections, and hypertrophy of nasal turbinates).

Methods

Eighty-one children with suspected adenoidal hypertrophy underwent nasal fibroendoscopy to assess the degree of adenoidal hypertrophy, and nasal nitric oxide on-line measurements by means of a dedicated chemiluminescence analyser.

Results

Nasal nitric oxide was successfully measured in 35 patients, most of whom had levels >450 parts per billion; the values were significantly higher (p = 0.031) in children with non-obstructive adenoids. There was no significant correlation with any other variable.

Conclusions

Preliminary data show above-normal nasal nitric oxide levels in children with adenoidal hypertrophy, especially those with non-obstructive adenoids. This suggests nitric oxide involvement in recurrent nasopharyngeal inflammation due to adenoidal hypertrophy.     

Effects of adenoidectomy in children with symptoms of adenoidal hypertrophy

The purpose of this study was to compare the preoperative symptoms of children who had adenoid hypertrophy with postadenoidectomy symptoms. Sixty children undergoing adenoidectomy were included in this prospective uncontrolled study at the Farabi Hospital of Karadeniz Technical University, an academic tertiary medical center. The symptoms of each child were described by their parents. Adenoidectomy with myringotomy alone or with tympanostomy tube placement was performed in all children. Two months after the operation, the children were re-evaluated for remaining or residual symptoms. Nasal obstruction, mouth breathing, snoring, hearing loss and nasal discharge were present preoperatively in 55 (91.6%), 51 (85%), 50 (83%), 28 (46%) and 45 (75%), respectively. We found that 53 of 60 children (88.3%) completely recovered from their preoperative symptoms. Of the remaining seven patients, four had persistent nasal obstruction, five mouth breathing, three snoring and two hearing loss. We also noted that the parents of 53 of 60 children were satisfied after the operation. Adenoidectomy provided significant relief and improvement of preoperative presenting symptoms, and it also showed a high rate of parent satisfaction.     

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.     

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。     

鼻用类固醇治疗儿童变应性鼻炎伴腺样体肥大疗效分析

目的 探讨儿童变应性鼻炎(AR)与腺样体肥大的关系, 评价鼻用类固醇治疗儿童变应性鼻炎伴腺样体肥大的疗效。方法 对照组为单纯腺样体生长儿童261例, 其中腺样体肥大190例(72.7%)。观察组为变应性鼻炎伴腺样体生长儿童162例, 其中腺样体肥大110例(67.2%)。两组均给予鼻用类固醇(丙酸氟替卡松喷剂)持续喷鼻3个月后于鼻内镜下复查。结果 对照组并发腺样体肥大构成比为72.7%,观察组并发腺样体肥大构成比为67.2%, 差异无统计学意义(χ²=1.16, P>0.05)。对照组采用鼻用类固醇治疗后有效腺样体体积减少112例(58.9%),观察组有效腺样体体积减小89例(80.9%)(χ²=19.04, P<0.01)。结论 经鼻用类固醇治疗, 变应性鼻炎伴腺样体肥大患儿腺样体体积减小程度较单纯腺样体肥大患儿明显。对变应性鼻炎合并腺样体肥大者可优先考虑应用鼻用类固醇激素。     

OSA-18量表评估腺样体肥大儿童生活质量

目的 采用儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)疾病特异性生活质量调查(OSA-18)量表, 评估腺样体肥大患儿生活质量, 以期了解OSA-18量表是否可作为临床评估腺样体肥大患儿生活质量状况的指标。方法 对符合入选标准的腺样体肥大患儿56例, 行电子鼻咽镜及多导睡眠监测(PSG)检查, 并采用OSA-18量表对其进行生活质量评估, 分析腺样体肥大病情程度与OSA-18评分的相关性。结果 80.36%的腺样体肥大患儿生活质量受到明显影响, OSA-18总体评分为"中度+重度"。OSA-18总体评分与呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO₂)及腺样体大小存在明显的相关关系。结论 腺样体肥大程度与OSA-18评分之间存在相关性, OSA-18量表评分可作为临床评估腺样体肥大患儿生活质量状况的指标。     

Long-term follow-up of children undergoing topical intranasal steroid therapy for adenoidal hypertrophy

BACKGROUND: Encouraging results concerning chronic obstructive nasal symptoms due to adenoid in pediatric population were reported by use of intranasal steroid for short period. Up to now, no data are available about outcomes of such therapy after long-term follow-up. We evaluated the utility of mometasone furoate aqueous nasal spray in children with adenoidal hypertrophy in long-term maintenance therapy. METHODS: All children affected by adenoidal hypertrophy and undergoing successful mometasone treatment for 4 months in a preceding trial were reassessed after a mean follow-up of 28 months. Based on the duration of maintenance therapy and eventual adenoid surgical treatment, three subgroups were identified: (1) children voluntarily suspending maintenance therapy and requiring surgery (Group A); (2) children continuing maintenance therapy but undergoing surgery (Group B); and (3) children continuing maintenance therapy but not undergoing surgery (Group C). Clinical and endoscopic evaluation in each group was compared to the assessment performed after the first 4 months of treatment. RESULTS: Six patients (Group A) voluntarily suspended maintenance therapy and underwent adenoidectomy. Either the overall symptom score or choanal obstruction of this group worsened compared to the previous trial. Adenoidal surgery was performed in another three children (Group B) for ear disease. Chronic obstructive nasal symptoms and adenoid size were unchanged compared to the preceding study. Finally, 12 patients were in Group C. The overall symptom score and choanal obstruction of this group showed a further significant improvement at this stage. CONCLUSIONS: This study describes the first long-term follow-up of children undergoing mometasone furoate aqueous nasal spray treatment for adenoidal hypertrophy. Voluntary suspension of maintenance therapy favors surgery of this disorder, whereas its regular administration may lead to successful results.     

Changes in serum levels of IGF-1 and in growth following adenotonsillectomy in children

OBJECTIVE: Adenotonsillar hypertrophy can cause upper airway obstruction and may be associated with growth delay in children. The objective of this study was to evaluate the long-term effects of adenotonsillectomy on height, weight, and body mass index (BMI) in children with sleep-disordered breathing (SDB). METHODS: Fifty-two children (mean age 6.2+/-2.3 years) clinically diagnosed with SDB were enrolled. Children were diagnosed and scheduled for adenotonsillectomy (T&A) based on their responses to the validated, 22-item Sleep Related Breathing Disorder (SRDB) scale and a physical examination that showed adenotonsillar hypertrophy. Weight, height, and BMI were evaluated before and 5 years after T&A. Serum levels of insulin-like growth factor-1 (IGF-1) were measured before and 1 month after T&A. RESULTS: Serum levels of IGF-1 were significantly higher at 1 month after T&A compared to before T&A (p<0.001). Thirty children (58%) returned for follow-up testing 5 years later. Their Z scores (standard deviation scores) for weight, height, and BMI of 30 children were significantly higher 5 years after T&A compared to before T&A (p<0.01). CONCLUSION: Children with SDB who undergo adenotonsillectomy show significant, long-term increases in weight, height and BMI, as well as a significant increase in serum levels of IGF-1.