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。     

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.     

鼻内镜下两种手术径路治疗儿童腺样体肥大的疗效比较

目的比较鼻内镜下经口和经鼻两种手术径路在儿童腺样体肥大切除术中的疗效。方法将80例腺样体肥大患儿随机分为经口组和经鼻组各40例,对两组患儿打鼾、鼻塞、耳闭等症状改善情况、术后并发症及随访6个月复发情况进行回顾性比较分析。结果两组患儿症状均全部消失或得到显著改善,经口组术后腺样体切割干净,无腺样体残留,仅2例术后出现轻微软腭损伤,随访无复发;经鼻组术后出现不同程度的软腭损伤、圆枕损伤、咽鼓管损伤、继发出血、腺样体残留或鼻腔粘连,2例再次手术。结论鼻内镜下经口腺样体切除术术后并发症少、复发率低、疗效可靠,优于经鼻腺样体切除术。     

鼻内镜下经口鼻联合腺样体切除术31例临床分析

目的观察鼻内镜辅助下经口鼻联合腺样体切除术的方法及疗效。方法31例确诊为腺样体肥大患者在鼻内镜辅助下经口鼻联合电动切割吸引器切除肥大腺样体。结果随访1～2个月，夜间打鼾、张口呼吸、鼻塞、鼻溢、听力下降等症状的恢复情况满意，无并发症。结论鼻内镜辅助下经口鼻联合腺样体切除术术野清晰，切除范围准确，手术方法易掌握，手术疗效肯定。     

鼻内镜辅助腺样体切除术与常规腺样体刮除术的疗效比较

目的 比较鼻内镜辅助经口腺样体切除术与常规腺样体刮除术的疗效.方法 腺样体肥大患儿36例,其中19例接受鼻内镜辅助经口腺样体切除术,17例施行常规腺样体刮除术,比较两种术式的疗效.结果 常规腺样体刮除术治疗组中5例存在腺样体残留,鼻内镜辅助经口腺样体切除术组无1例有腺样体残留.结论 鼻内镜辅助经口腺样体切除术式是治疗腺样体肥大的最佳手术方法.     

70°鼻内镜下儿童腺样体切除术825例临床分析

目的研究70°鼻内镜下儿童腺样体切除术的方法和疗效。方法对825例腺样体肥大患者采用70°鼻内镜下腺样体切除术,观察其疗效。结果 825例腺样体肥大患者术后所有主观症状消失或明显好转,听力学检查均恢复正常,复查鼻咽侧位片或电子鼻咽镜见鼻咽部光滑,后鼻孔通畅,咽鼓管咽口无狭窄。术后随访3～20个月所有患者无复发,并发症少见。结论 70°鼻内镜下腺样体切除术是治疗腺样体肥大的有效手术方式。     

腺样体肥大四种手术方式比较

目的 总结138例腺样体肥大患者手术方式,评价四种手术方式的特点。方法 对138例腺样体肥大患者分别采用四种术式进行治疗,其中传统的腺样体刮除术20例(A组),腺样体刮除+鼻内镜下残余腺样体咬切术63例(B组),鼻内镜下腺样体切吸术25例(C组),鼻内镜下腺样体等离子融切术30例(D组),统计各组的治疗效果、腺样体残留率、并发症、手术时间、出血量等,比较不同术式的优缺点。结果 A组的有效率为90%,其余三组均达到100%;残留率以A组最高,为60%,D组残留率为6.67%,B、C两组无残留;共有4例术后出血(A组1例、B组2例、C组1例),鼻腔粘连共出现6例(B组4例,C组2例);在手术时间的比较上,A组和D组无显著性差异,B组和C组无显著性差异,其余两两比较均有显著性差异,即A组和D组在手术时间上优于B组和C组。在出血量的比较上, D组出血量最少,A组和B组次之,C组出血量最多。结论 传统的刮除术因残留率过高需摒弃;等离子融切术虽然手术时间短、出血少,但价格昂贵,可用于经济条件好、对失血要求高的患者;一般患者可选用腺样体刮除+鼻内镜下残余腺样体咬切术或鼻内镜下腺样体切吸术,相对而言前者更为简单易行,经济实惠。     

鼻内镜口腔途径选择性切除儿童肥大腺样体的手术技巧及疗效分析

目的 探讨鼻内镜下经口腔电动吸切选择性切除儿童肥大腺样体手术方式及疗效分析.方法 对有多种典型临床症状(包括打鼾、鼻塞、流脓涕、听力下降、口颌面部及生长发育畸形等)的56例腺样体肥大患儿,全麻下开口器撑开口腔并拉起软腭,经口腔插入70°鼻内镜显露鼻咽部肥大的腺样体,采用弯头正反向切割吸引刀头,明视下选择性吸切阻挡后鼻孔区的肥大腺样体部分,其余腺体组织保留,并与传统的盲刮法(79例)及鼻内镜下全切除法(25例)进行疗效比较.结果 本组全部患儿术后1～3天打鼾症状基本消失,未见术后并发症.手术创伤轻,出血少,患儿恢复快,经随访1～6个月,鼻部阻塞症状消失及明显改善49例(占87.5％),13例有耳部症状者治愈及明显好转者9例(占69.2％).而对照组盲刮法鼻症状改善有效率(62％),术后反应较重,出血较多;全切法有效率(84％),出血较多,术后反应较重.结论 采用鼻内镜经口明视下选择性吸切阻挡后鼻孔区的肥大腺样体部分,具有手术在明视下操作,术腔较宽敞、安全有效、微创、出血少及术后恢复快等优点,在众多的手术方法中是一种较为理想的选择术式.     

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。     

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。     

腺样体铲除术对咽鼓管功能影响的研究

目的:观察鼻内镜下经口腔腺样体铲除术与传统腺样体铲除术对腺样体肥大患者咽鼓管功能的影响。方法:选取诊断为腺样体肥大且不伴中耳炎的住院患者为研究对象,分别采用鼻内镜下经口腔腺样体铲除术和传统腺样体铲除术,在治疗前及治疗3个月后分别检测咽鼓管功能。结果:2组患者治疗前咽鼓管功能检查无统计学差异,治疗后与术前相比,2组均有统计学差异;治疗后2组之间差异也有统计学意义。结论:鼻内镜下经口腔腺样体铲除术和传统腺样体铲除术均可改善腺样体肥大患者的咽鼓管功能,且鼻内镜下经口腔腺样体铲除术对咽鼓管功能的改善优于传统腺样体铲除术。     

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.     

Enlarged adenoid and adenoidectomy in adults: endoscopic approach and histopathological study

Adenoid enlargement is uncommon in adults and because examination of the nasopharynx by indirect posterior rhinoscopy is inadequate, many cases of enlarged adenoid in adults are misdiagnosed and accordingly maltreated. This study was conducted on 35 cases of enlarged adenoid aged between 20 and 42 years. The nasal endoscope was utilized to identify the adenoid mass. Adenoidectomy under transnasal endoscopic control was performed and all the excised material was sent for histopathological examination. Adenoidectomy resulted in marked improvement in 94 per cent of cases without major complications. Histopathological examination revealed non-specific inflammatory reaction in 15 cases (43 per cent), pure reactive changes, predominantly follicular hyperplasia, in two cases (6 per cent) and mixed pattern in 18 cases (51 per cent). Endoscopic follow-up for an average 17 months identified recurrence in only two patients. It was concluded that enlarged adenoid tissue in adults has some histopathological differences from that in children and adenoidectomy under transnasal endoscopic control is safe and reliable.     

Partial Adenoidectomy

Adenoidectomy in the presence of an inadequate palate may result in velopharyngeal insufficiency. When an adenoidectomy is indicated in a child whose palate is not fully adequate, a partial adenoidectomy may be considered. Partial adenoidectomy involves removing the upper part of the adenoid for relief of nasal obstruction while leaving the lower portion of the adenoid intact to ensure velopharyngeal competence. Fifty-eight children underwent partial adenoidectomy over a 4-year period; 55 of these children had preoperative nasal obstruction; 49 had a tonsillectomy done at the same time; and 2 had had a previous T&A. The rationale for retaining the lower portion of the adenoid includes a short soft palate, decreased palatal mobility, a mildsubmucous cleft palate, huge tonsils pushing the palate anteriorly, and a short hard palate. The relief of nasal obstruction was excellent. There were no primary postoperative hemorrhages, and none of the 58 children developed velopharyngeal insufficiency following partial adenoidectomy.     

Effect of enlarged adenoids on arterial blood gases in children

The enlarged adenoid is a common disorder in children resulting in nasopharyngeal obstruction. Many authors suggest that increased nasal resistance to respiration may cause disturbances in the pulmonary ventilation and carry the risk of obstructive sleep apnoea and/or cardiopulmonary syndrome. This study comprised 30 children complaining of long-standing nasal obstruction due to enlarged adenoids. Adenoidectomy was performed and the arterial blood gases were measured before and one month after surgery. Twelve normal children were also included as controls. Statistical evaluation of the results showed that O2 saturation and arterial O2 tension (PaO2) were significantly low before the operation, and increased significantly after surgery. Arterial CO2 tension (PaCO2) was insignificantly low before operation, but decreased significantly after adenoidectomy. It was concluded that enlarged adenoid may be associated with ventilatory impairment which is reversible after adenoidectomy.     

Endoscopic nasopharyngeal exploration at the end of conventional curettage adenoidectomy

Adenoid hypertrophy (AH) is a common cause of airway obstruction in children and its recurrence after conventional curettage adenoidectomy is not rare. The purpose of this study is to assess the efficacy of endoscopic nasopharyngeal exploration at the end of curettage adenoidectomy on decreasing the incidence of adenoid re-hypertrophy. Three hundred and fifty children diagnosed as having AH, underwent conventional curettage adenoidectomy by a single surgeon. The cases were randomly divided into two equal groups A and B, group B were further subjected to nasopharyngeal exploration by the nasal endoscope after removal of their adenoids with cauterization of any visible residuals, while group A were not subjected to this endoscopic maneuver. Follow-up was carried out for at least 2 years; flexible nasopharyngoscopy was used for detection of recurrent AH. Cases that were not subjected to endoscopic nasopharyngeal exploration (group A) showed a high recurrence rate (6.6%), while explored cases (group B) showed a low incidence of recurrence (1.18%). Most recurrence of group A (6%) was detected within the first year of the follow-up period which may indicate re-growth of residual adenoidal tissues that were missed during conventional curettage adenoidectomy. Endoscopic nasopharyngeal exploration at the end of conventional curettage adenoidectomy is a useful method in decreasing the incidence of recurrent AH.     

鼻内镜下腺样体切除治疗儿童慢性咳嗽疗效分析

目的：方法:对慢性咳嗽儿童行鼻内镜检查,筛选出腺样体肥大并感染患儿39例,全麻下行鼻内镜下腺样体切除。结果：39例患儿中,29例痊愈,8例好转,2例手术前后无明显变化,转诊儿科,诊断咳嗽变异性哮喘（CVA）,收儿科治疗。 总有效率为95%。结论：对于腺样体肥大并常有感染的患儿,行鼻内镜下腺样体切除治疗继发性慢性咳嗽是合理和有效的。     

鼻内镜下腺样体切除治疗幼儿阻塞性睡眠呼吸暂停低通气综合征的疗效观察

目的 探讨鼻内镜下腺样体切除治疗幼儿阻塞性睡眠呼吸暂停综合征的疗效。方法 我们为16例诊断为阻塞性睡眠呼吸暂停综合征且鼻咽侧位片检查确诊为腺样体肥大的患儿施行了鼻内镜下腺样体切除术,手术在经口插管全身麻醉下进行。结果 打鼾、鼻塞等症状消失或减轻,随访6～12个月无复发。结论 鼻内镜下腺样体切除治疗幼儿阻塞性睡眠呼吸暂停综合征效果确切。     

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.