腺样体肥大儿童睡眠结构的分析

目的:研究腺样体肥大(AH)对儿童睡眠结构的影响。方法:通过多导睡眠图分析了47例AH患儿(AH组)睡眠结构,并与11例同龄儿童(正常组)睡眠结构正常值进行比较。结果:与同龄儿童睡眠结构正常值相比AH组的睡眠结构存在如下异常:①S1期所占比例增加:AH组15.4±9.3,正常组7.9±6.8(P<0.01);S2期所占比例减少:AH组41.8±9.7,正常组46.7±7.6(P<0.01);Delta期所占比例增加:AH组26.2±10.6,正常组23.3±8.7(P>0.05);REM期所占比例减少:AH组7.7±4.9,正常组27.3±5.6(P<0.01)。②总醒觉指数:AH组32.8±26.03,高于正常儿童18.3±12.2(P<0.05)。③REM潜伏期:AH组(157.1±71.4)min,比正常儿童(84.5±36.5)min延长约2倍(P<0.01),AH组睡眠效率(89.6±8.4)%,略低于正常值的(90.2±8.7)%(P>0.05)。结论:AH主要引起睡眠结构紊乱、醒觉的指数增加、REM睡眠剥夺睡眠片段,但深睡眠时间增加。     

鼻内镜下腺样体切除术与常规腺样体刮除术的疗效比较

目的:比较鼻内镜下腺样体切除术与常规腺样体刮除术两种术式的疗效。方法:将资料完整的34例腺样体肥大患者分为鼻内镜下腺样体切除术18例(切除术组),常规腺样体刮除术16例(刮除术组);采用声反射鼻测量等参数观察手术疗效,随访6~12个月并进行回顾性分析。结果:切除术组平均手术时间5.25(1.25~15.75)min,刮除术组8.5(1.5~35.0)min,两组差异有统计学意义(P<0.01);切除术组平均出血量50(10~125)ml,刮除术组平均出血量75(5~175)ml,两组比较无统计学意义(P>0.05)。切除术组术后出血1例,刮除术组术后脱水1例。声反射鼻测量计检查鼻咽部最小横截面积,切除术组术前(0.75±0.58)cm2,术后3个月为(1.94±0.63)cm2,术后12个月为(1.99±0.44)cm2;刮除术组术前(0.80±0.51)cm2,术后3个月为(1.83±0.81)cm2,术后12个月(1.89±0.37)cm2。两组手术前后最小横截面积比较差异有统计学意义(均P<0.01),手术前后两组间最小横截面积比较差异均无统计学意义(均P>0.05)。结论:鼻内镜下腺样体切除术具有切除快、出血少等优点。声反射鼻测量计是评估腺样体切除术疗效的客观指标。     

儿童腺样体肥大与中耳咽鼓管功能相关性分析

目的:探讨腺样体大小与中耳功能和咽鼓管功能的相关性。方法:回顾性分析2004年2月~2004年10月因腺样体肥大收入院手术患儿的中耳功能,并比较腺样体肥大患儿和正常同龄儿童的咽鼓管功能的差异。结果:①腺样体大小与中耳压力有明显的负相关性(r=-0.41,P<0.05);②腺样体肥大患儿咽鼓管功能(13.9±13.2)daPa,与正常儿童咽鼓管功能(22.5±10.4)daPa比较,差异有统计学意义(t=-3.1,P<0.01);③患儿腺样体的大小程度与咽鼓管功能无明显相关性(r=-0.19,P>0.05)。结论:腺样体病理性肥大可引起咽鼓管功能障碍,是分泌性中耳炎(SOM)的发病基础。     

应用声反射鼻腔测量腺样体肥大患儿的鼻及鼻咽气道

目的:研究声反射鼻腔测量对腺样体肥大患儿的诊断与手术疗效评价方面的临床应用价值。方法:对23例正常儿童(正常儿童组)及27例腺样体肥大患儿(腺样体肥大组)进行坐位声反射鼻腔测量。结果:腺样体肥大组术前总鼻气道阻力(NAR)为[(0.44±0.17)kPa.L-1.min-1],较正常儿童组[(0.33±0.17)kPa.L-1.min-1]增大,差异有统计学意义(P<0.05),双侧鼻咽部容积(NPV)为[(14.74±5.01)cm3],较正常儿童组[(19.77±5.77)cm3]减小,差异有统计学意义(P<0.01);腺样体肥大组术后总NAR为[(0.36±0.21)kPa.L-1.min-1],较术前减小,差异有统计学意义(P<0.05),双侧NPV为[(17.93±4.56)cm3],较术前增大,差异有统计学意义(P<0.05)。结论:声反射鼻腔测量在腺样体肥大的诊断和疗效判定方面具有重要意义。     

耳内镜下儿童腺样体吸切术100例临床分析

目的介绍一种既安全、便捷又符合微创要求的儿童肥大腺样体切除术式。方法对100例腺样体肥大的儿童,在耳内镜指引下应用40°正反向切割吸引刀头,经口行肥大腺样体吸引切除,并分析其疗效。结果100例患儿术后症状消失者89例,症状明显改善者11例,有效率100%,术后随访无腺样体残留及并发症发生。结论耳内镜下经口行儿童肥大腺样体吸切术,具有安全可靠、操作简单、切除彻底、疗效显著等优点,是一种理想的腺样体肥大切除术式。     

扁桃体加腺样体切除术对阻塞性睡眠呼吸暂停低通气综合征患儿睡眠结构的影响

目的探讨扁桃体加腺样体切除术对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿睡眠结构的影响。方法选取45例OSAHS患儿行扁桃体加腺样体切除术,比较术前和术后3个月睡眠结构参数,包括睡眠效率（SE）、S1期比例、S2期比例、SWS期比例、REM期比例、觉醒指数（AI）、觉醒时间比例（AT%）、SaO2低于90%的持续时间占睡眠时间的百分比（SLT90%）、最低血氧饱和度（LSaO2）和氧减饱和度指数（ODI4）,并与正常儿童对照组比较,观察患儿各项指标的变化。结果 OSAHS患儿SE、SWS期、REM期和LSaO2比对照组均降低（P〈0.05）,S 1期、O D I 4和S LT 9 0%比对照组升高（P〈0.0 1）,AI和AT%比对照组升高（P〈0.05）。OSAHS患儿术后3个月SE、SWS期、REM期和LSaO2比术前均升高（P〈0.05）,S1期、AI、AT%、ODI4和SLT90%比术前降低（P〈0.05）。结论 OSAHS患儿存在睡眠结构紊乱,扁桃体加腺样体切除术能有效改善睡眠结构紊乱。     

OSA儿童腺样体扁桃体切除术后的生活质量分析

目的:研究阻塞性睡眠呼吸暂停(OSA)儿童腺样体扁桃体切除术后生活质量的变化。方法:对符合入选标准的66例OSA儿童实施腺样体扁桃体切除术。患儿家长于术前及术后6～18个月完成OSA-18生活质量问卷调查,术前和术后调查问卷的评分用配对t检验进行比较。结果:OSA-18总分术前平均分为70.59(SD=15.015),术后为39.94(SD=14.232),OSA-18术前评分显著高于术后评分(P<0.01)。术前术后的OSA-18总分,睡眠紊乱、身体症状、情绪影响、白天问题及看护者关心的问题五项评分,以及每一小项评分,均较术前有显著降低(P<0.01)。结论:OSA严重影响儿童生活质量,腺样体扁桃体切除术后患儿生活质量有显著改善。     

鼻内镜下腺样体肥大的手术治疗

目的探讨鼻内镜下经鼻腺样体切除术的可行性和优点。方法在鼻内镜下对较大儿童及成人腺样体肥大经鼻行腺样体切除术48例,治疗由腺样体肥大引起的睡眠呼吸障碍、鼻阻塞和咽鼓管功能障碍等。结果术后腺样体切除干净,无残体存留,鼻咽部结构显示良好,无出血、咽鼓管损伤等并发症,随访0.5~2年,病人症状消失。结论鼻内镜下腺样体肥大切除手术能在直视下进行,增加了手术的安全性和准确性,病变切除更加彻底,手术疗效明显,并发症少。     

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。     

关于儿童阻塞性睡眠呼吸暂停低通气综合征我们面临的问题

儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)为耳鼻喉科常见病,其发病率高,且严重危害儿童生长发育。儿童OSAHS的发病与多种因素有关,其中最常见的原因是扁桃体肥大及腺样体肥大。扁桃体腺样体切除术是治疗儿童OSAHS的首选方法,但是仍然有一些问题需要面对,现就儿童OSAHS的术前评估、术后对生活质量的影响、术后继续干预等问题进行述评。     

阻塞性睡眠呼吸暂停低通气综合征手术治疗对儿童记忆的影响

目的探讨儿童阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）手术治疗对儿童记忆的影响.方法对80例腺样体肥大合并OSAHS儿童手术前后进行韦氏记忆量表检测、多导睡眠描记（polysomnography,PSG）监测,结果与60例腺样体或扁桃体肥大但不伴有OSAHS的儿童进行比较.结果 80例患儿记忆商（MQ）及各分项记忆指标术前均低于术后,有非常显著性差异（P＜0.01）;术后的各分项记忆指标虽然亦低于对照组,但已无统计学差异（P＞0.05）.结论儿童OSAHS手术治疗有助于改善儿童的短时记忆.     

Endoscopic Adenoidectomy in Children With Otitis Media With Effusion and Mild Hearing Loss

ObjectivesSurgical management of children with chronic otitis media with effusion (OME) includes tympanostomy tube insertion or adenoidectomy, alone or with myringotomy and tube insertion. The aim of this study was to compare the effectiveness of transoral microdebrider endoscopic-assisted adenoidectomy (TOMEA) and traditional adenoidectomy in the management of children with mild hearing loss due to OME and chronic adenoiditis.MethodsThis prospective, double-blind and controlled study involved 120 consecutive patients aged 4–12 years, who were randomised 1:1 to undergo TOMEA or traditional adenoidectomy under general anesthesia. All the patients underwent a complete otolaryngological examination, including nasopharyngeal fibre endoscopy (NFE), pneumatic otoscopy, otomicroscopy, tympanometry and supraliminar tonal audiometry, upon enrolment, and three and nine months postoperatively.ResultsThere were no statistically significant differences in age or gender distribution between the TOMEA group (mean age, 4.9±1.1 years; 53.3% males) and the traditional adenoidectomy group (mean age, 5.3±0.9 years; 56.7% males). Both procedures led to a significant improvement in choanal patency (P<0.01) and all of the otological and audiological parameters (P<0.01) 3 and 9 months postoperatively, although postoperative NFE showed that the mean percentage of residual choanal obstruction was significantly less in the TOMEA group (P=0.02). There was no significant between-group difference in the percentage of children with tympanic membrane changes, but the postoperative prevalence of children with a type B tympanogram was significantly lower in the TOMEA group after 3 (15.0% vs. 31.7%, P=0.05) and 9 months (18.3% vs. 38.3%, P=0.02), as was the percentage of children with mild conductive hearing loss (3.3% vs. 23.3%, P<0.01; and 8.3% vs. 28.3%, P<0.01).ConclusionAlthough both TOMEA and traditional adenoidectomy are effective in treating children with mild hearing loss due to adenoidal hypertrophy and OME, the former achieves the greater reduction in residual adenoidal hypertrophy and better audiological outcomes.     

腺样体扁桃体切除术对阻塞性睡眠呼吸暂停低通气综合征儿童生活质量的影响

目的　探讨腺样体扁桃体和（或）切除术对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿生活质量的影响。方法　对OSAHS患儿行疾病特异性生活质量调查表（OSA-18）,分析术前、术后结果差异,评估生活质量变化。结果　246例患儿临床症状均缓解,OSA-18总分由（64.80±8.95）降至（30.11±4.49）,差异具有统计学意义（P <0.01）。生活质量改善总体有效率达99.60%,睡眠障碍、全身症状、对监护人的影响显著改善。结论　腺样体和（或）扁桃体切除术能够直接解除呼吸道梗阻,提高患儿睡眠质量、生活质量,可作为儿童OSAHS的主要治疗手段。     

儿童腺样体肥大手术切除与分泌性中耳炎

目的 探讨手术治疗儿童腺样体肥大对分泌性中耳炎的影响。方法 回顾分析手术治疗的腺样体肥大患儿206例,其中并发分泌性中耳炎97例136耳,观察手术治疗前后鼓室功能图的变化。结果 腺样体切除术后,并发分泌性中耳炎患者得到有效治疗,其中治愈103耳;好转19耳;复发或无明显改善14耳,慢性中耳炎反复发作12耳,持续病程超过2年。结论 分泌性中耳炎的转归与腺样体肥大的程度及临床病程的持续时间有关,腺样体切除术有利于咽鼓管功能的恢复。     

EB病毒在儿童腺样体肥大和扁桃体炎组织内的定量研究及意义

目的:探讨EB病毒在儿童慢性扁桃体炎、腺样体肥大中的流行病学特点及其在儿童腺样体肥大、慢性扁桃体炎疾病发病机制中的作用.方法:采用实时荧光定量PCR技术对52例慢性扁桃体炎、腺样体肥大患儿手术摘除的腺样体、扁桃体组织及血浆标本进行EB病毒定量检测.结果:患有慢性扁桃体炎和(或)腺样体肥大的儿童扁桃体、腺样体组织中EB病毒感染率为51.9%;其中男性患儿EB病毒感染率为50.0%,女性患儿为55.6%,两者差异无统计学意义(P＞0.05).扁桃体组织EB病毒感染率为40.4%,腺样体组织为48.9%,差异无统计学意义(P＞0.05).学龄组(7～14岁)患儿扁桃体和腺样体组织EB病毒感染率为65.5%,明显高于学龄前组(2～6岁)患儿的感染率(34.8%).比较轻、中、重度肥大的腺样体组织中EB病毒-DNA拷贝数发现:重度肥大组EB病毒-DNA拷贝数明显高于其他两组(P＜0.05).52例患儿血浆标本检测发现:EB病毒-DNA拷贝数均在正常范围内(＜1×10~3 copies/ml).结论:腺样体肥大组织与慢性扁桃体炎组织对EB病毒有相同的易感性,男、女性患儿的扁桃体和腺样体组织对EB病毒易感性基本相同,且随着患儿年龄的增长、病程的延长,EB病毒的感染率也会相应增高.腺样体的增生、肥大与EB病毒的感染有一定相关性.     

Comparison of polygraphic parameters in children with adenotonsillar hypertrophy with vs without obstructive sleep apnea

OBJECTIVE: To compare the polygraphic parameters in children with adenotonsillar hypertrophy (ATH) with vs without obstructive sleep apnea (OSA). DESIGN: Prospective controlled study. SETTING: Hospital-based pediatric otolaryngology practice. PATIENTS: Children with ATH. INTERVENTIONS: The children enrolled in the study underwent polysomnography. According to the apnea index (AI) (a patient who has at least 1 episode of apnea per hour of sleep is considered to have apnea), they were classified as having ATH with OSA or ATH without OSA. MAIN OUTCOME MEASURES: We evaluated polysomnography parameters to describe the macrostructure of sleep (sleep efficiency, nonrapid eye movement stages 1-4, and rapid eye movement) and the microstructure of sleep (using electroencephalogram results and movement arousals) and respiratory events. RESULTS: Twenty children were classified as having ATH with OSA and 17 as having ATH without OSA. We found no significant differences in sleep macrostructure and microstructure between the ATH groups with vs without OSA. Apnea-hypopnea indices (AHI), respiratory disturbance events, hypopnea events in rapid eye movement and AHI, AI, respiratory disturbance events, obstructive events, hypopnea events, the duration of obstructive events, and hypopnea events during nonrapid eye movement were more frequent or of longer duration in children with OSA vs those without OSA (P < .05). CONCLUSIONS: Obstructive sleep apnea should be considered a disorder on the continuum of ATH. To our knowledge, our results clearly and for the first time demonstrate that more severe respiratory disturbances seem to be important risk factors for ATH to develop into OSA in children.     

腺样体肥大儿童分泌性中耳炎发生率及其影响因素分析

目的探讨腺样体肥大儿童分泌性中耳炎(SOM)的发病情况及其影响因素。方法对6 256例住院手术治疗的腺样体肥大儿童进行纤维鼻咽镜或鼻内镜及声导抗检查,对声导抗结果异常的患儿行纯音测听或ABR检查,统计分析不同年龄、不同腺样体肥大程度及不同病程患儿SOM的发生率。结果 6 256例腺样体肥大患儿中合并SOM者2 702例(43.19%,2 702/6 256),而病史中有明确听力减退主诉者仅654例(10.45%,654/6 256);3～5岁年龄段SOM的发生率最高,为69.76%(1 119/1 604),随年龄增长,SOM发生率逐渐下降;Ⅲ°腺样体肥大患儿中SOM发生率为61.73%(1 639/2 655),显著高于Ⅰ度(21.11%,163/772)、Ⅱ度(31.81%,900/2 829)腺样体肥大患儿(P<0.05);不同病程腺样体肥大患儿中SOM发生率差异无统计学意义(P>0.05)。结论本组腺样体肥大患儿SOM发生率为43.19%,低龄和腺样体肥大程度是腺样体肥大患儿并发SOM的影响因素,而病程对其无明显影响。     

腺样体切除术对鼻腔黏膜纤毛清除功能的影响

目的探讨腺样体切除术对鼻腔黏膜纤毛清除功能的影响。方法对2012年1月~2015年6月在我科住院行腺样体切除术(或同时行扁桃体切除术)并符合研究条件的患者89例进行总结分析。患者分为两组：A组单纯腺样体肥大者47例,B组腺样体肥大合并慢性鼻-鼻窦炎(chronic rhinosinusitis, CRS)者42例。所有患者术前及术后1个月行糖精试验以获得黏膜纤毛清除时间(mucociliary clearance time,MCT),手术中测量鼻腔的长度后计算出黏膜纤毛清除速率(mucociliary clearance velocity, MCV)。另将35例正常儿童作为对照组,进行一次糖精试验获得纤毛清除时间。比较A、B两组患者手术前后鼻腔黏膜纤毛清除时间及清除速率,分析腺样体切除术对鼻腔黏膜纤毛清除功能的影响。结果A组患者术前及术后的MCT分别为（13.64±3.26）min,（9.04±1.78）min;B组术前及术后的MCT分别为（15.85±4.63）min,（11.90±2.70）min。A组患者术前及术后的MCV分别为（2.81±0.73）mm/min、（4.16±0.82）mm/min;B组术前及术后的MCV 分别为（2.45±0.75）mm/min、（3.35±0.83）mm/min。正常对照组的MCT及MCV分别为（7.24±2.03）min, （5.53±1.79）mm/min。两组手术前后的MCT及MCV差异具有统计学意义(P＜0.01)。结论腺样体切除术可以改善鼻腔黏膜纤毛清除功能。     

鼻内镜手术联合鼻用糖皮质激素治疗腺样体肥大性

目的 探讨鼻用糖皮质激素辅助鼻内镜下腺样体切除术治疗腺样体肥大性小儿鼾症的临床效果及安全性。 方法 选取腺样体肥大性小儿鼾症患者98例为研究对象,采用随机平行对照法将其分为2个组各49例。对照组给予鼻内镜下腺样体切除术,以及口服头孢克洛颗粒、雾化吸入地塞米松等常规治疗。观察组在对照组基础上给予鼻用糖皮质激素喷鼻。比较两组治疗有效率、不良反应发生率、治疗前后鼻咽侧位片A/N值、呼吸暂停低通气指数、睡眠质量、免疫与炎症因子水平的差异。 结果 观察组总有效率为89.80%(44/49),对照组为73.47%(36/49),观察组显著高于对照组(χ2=4.356, P=0.037)。观察组出现鼻出血1例,鼻前庭干燥感1例,发生率为4.08%,对照组未见鼻出血及鼻前庭干燥感发生,两组不良反应发生率比较差异无统计学意义(P>0.05)。治疗前,两组鼻咽侧位片A/N值、呼吸暂停低通气指数及睡眠质量比较差异无统计学意义(P>0.05),治疗后两组鼻咽侧位片A/N值、呼吸暂停低通气指数及睡眠质量均改善,且组间比较差异有统计学意义(P<0.05)。治疗前,两组IgE、LTE4、TNF-α、IL-6、IL-8比较差异无统计学意义(P>0.05),治疗后,两组IgE、LTE4、TNF-α、IL-6、IL-8均降低,且组间比较差异有统计学意义(P<0.05)。 结论 对腺样体肥大性小儿鼾症患者,给予鼻用糖皮质激素辅助鼻内镜腺样体切除术治疗能够通过抑制炎症因子释放,改善打鼾、鼻塞等临床症状,且风险较小,患儿睡眠质量较高,值得推广应用。     

Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy

OBJECTIVES: To quantify the incidence of intranasal extension of adenoid tissue and residual adenoidal obstruction of the posterior choanae following traditional curette adenoidectomy to determine the efficiency of adenoid curettage and the usefulness of intraoperative endoscopic examination and powered-shaver adenoidectomy in achieving better postnasal patency. DESIGN: Prospective intraoperative endoscopic evaluation of the posterior choanae and nasopharynx of a case series of 130 patients before and after curette and powered-shaver adenoidectomy. SETTING: Tertiary referral center. PATIENTS: One hundred thirty consecutive pediatric patients with obstructive adenoidal hypertrophy undergoing adenoidectomy. MAIN OUTCOME MEASURES: The degree of residual postnasal obstruction due to adenoid tissue was assessed endoscopically (grades 0-3) after curette and adjuvant powered-shaver adenoidectomy. The presence of intranasal adenoid tissue was also recorded. RESULTS: Following traditional curette adenoidectomy, 51 (39%) of 130 patients had residual obstructive adenoid with 42 patients (32%) having occlusive intranasal adenoid tissue. Having determined the presence of remaining obstructive tissue with intraoperative nasal endoscopy in these 51 patients, complete airway patency was achieved with powered-shaver adenoidectomy. CONCLUSION: The presence of intranasal extension of adenoids obstructing the posterior choanae is common in children with adenoid hypertrophy. Traditional adenoidectomy is ineffective in removing this tissue and may also leave obstructive tissue high in the nasopharynx. Intraoperative nasal endoscopy allows assessment of the completeness of surgery. Powered-shaver adenoidectomy enables complete removal of obstructive adenoid tissue thereby ensuring postnasal patency.