An audit of the complications of paediatric tonsillectomy,adenoidectomy and adenotonsillectomy

Tonsillectomy, adenoidectomy and adenotonsillectomy are among the commonest surgical procedures undertaken in children. The notes of 413 consecutive children having tonsillectomy, adenoidectomy or adenotonsillectomy were analysed retrospectively to determine complication rates. Of the total number of children, 5.6% had at least one complication, the most common of which was haemorrhage occurring as a first complication in 3.9% (16 children). Three children with bleeding required active treatment (0.7%), one requiring transfusion and two requiring a return to theatre, all within 3 1/2 hours of operation. The incidence of reactionary bleeding was not associated with the grade or seniority of the surgeon. Six children (1.5%) developed a fever post-operatively, of which one required antibiotic treatment. On the basis of these results it is feasible for such procedures to be carried out on a day-care basis.     

羟考酮联合舒芬太尼在小儿扁桃体腺样体切除术的应用效果

目的:探讨羟考酮联合舒芬太尼在小儿扁桃体腺样体切除术的应用价值。 方法:选择全身麻醉下行择期扁桃体腺样体切除的患儿 80 例,按随机数表法分为舒芬太尼组(S 组)和羟考酮+舒芬太尼组(O+S 组)各 40 例。 监测麻醉诱导前(T0 )、气管插管时(T1 )、拔除气管导管时(T2 )、拔管后 5 min(T3 )、离开麻醉后监测治疗室(PACU)时(T4 )的心率和平均动脉压;记录 T3 及T4 患儿疼痛行为量表(FLACC)评分及儿童麻醉苏醒期躁动量表(PAED)评分。 记录患儿麻醉诱导时呛咳、在 PACU 躁动、恶心呕吐、呼吸抑制等不良反应发生率。 结果:S 组患儿 T1 、T2 时及 O+S 组患儿 T1 时的心率和平均动脉压较 T0 时升高(P<0. 05);O+S 组患儿 T2 时心率和平均动脉压低于 S 组(P<0. 05)。 O+S 组患儿 T3 、T4 时 FLACC 评分及 T3 时 PAED 评分低于 S 组,诱导时呛咳、术后躁动的发生率低于 S 组(P<0. 05)。 结论:与单用舒芬太尼相比,小儿扁桃体腺样体切除术中采用羟考酮 0. 2 mg / kg+舒芬太尼 0. 2 μg / kg 联合诱导麻醉,可提高术后镇痛满意度,减少呛咳及术后躁动等不良反应的发生。     

Surgical management of obstructive sleep apnea in children with cerebral palsy.

OBJECTIVES: To evaluate the surgical management of obstructive sleep apnea in children with cerebral palsy. STUDY DESIGN: Retrospective review of 27 children with cerebral palsy who underwent surgical treatment for obstructive sleep apnea. METHODS: Charts were reviewed. Data gathered included primary complaint, coexisting illnesses, initial procedure performed, age at initial surgery, number of days the child was monitored postoperatively in the intensive care unit, notation of postoperative respiratory distress and management, and outcome. RESULTS: Nineteen children underwent adenotonsillectomy for initial treatment of obstructive sleep apnea. Three of these children also had a uvulectomy. Six children had an adenoidectomy alone as their initial procedure. Neither uvulopalatopharyngoplasty nor tracheostomy was performed as an initial procedure. Mean follow-up was 34 months. Seventy-six percent of these children have not required any further surgery. Of the six children who have undergone further surgery, one has required a revision adenoidectomy, and another underwent a tonsillectomy and uvulectomy 2 months after the initial adenoidectomy. Four children ultimately required a tracheotomy. CONCLUSIONS: Eighty-four percent of these children were successfully managed without a tracheotomy. We recommend tonsillectomy and/or adenoidectomy for initial surgical treatment of obstructive sleep apnea in children with cerebral palsy.     

鼓膜置管联合鼻内镜下腺样体切除术对分泌性中耳炎患者听力水平及复发的影响

目的 探讨鼓膜置管联合鼻内镜下腺样体切除术对分泌性中耳炎(SOM)患儿听力水平及复发的影响.方法 选择2017年2月至2019年1月江西省新余市人民医院治疗的SOM患儿82例(106耳),按随机数字表法将其分为两组,每组各41例.对照组接受鼻内镜下腺样体切除术治疗,观察组接受鼓膜置管与鼻内镜下腺样体切除术联合治疗.比较...     

经口在鼻内镜下切除265例腺样体的临床体会

目的 探讨鼻内镜下经口腺样体切除术的疗效和优缺点.方法 在鼻内镜下对儿童腺样体肥大265例,采用切削吸引进行治疗,并随访观察疗效.结果 腺样体切除彻底,术后无出血,无残体存留,鼻咽部结构良好,咽鼓管无损伤.随访6～12个月,患者睡眠障碍、鼻阻塞、流脓涕及耳闷塞等症状消失.结论 鼻内镜下腺样体肥大切除能在直视下操作,结合多种手术方法更能彻底切除腺样体,手术疗效显著,并发症少.     

电动吸切器腺样体切除术治疗慢性鼻窦炎的疗效及术后出血的影响因素分析

目的 基于人工神经网络模型,探讨电动吸切器腺样体切除术治疗慢性鼻窦炎的疗效及术后出血的影响因素。方法 回顾性分析2019年9月-2022年9月该院收治的343例慢性鼻窦炎患者的临床资料,将采用电动吸切器腺样体切除术治疗的患者设为观察组(275例),将采用腺样体刮除术治疗的患者设为对照组(68例)。按照随机数表法,将观察组患者以4∶1的比例,分为训练集(220例)和验证集(55例);根据术后是否出血,将训练集患者分为术后出血组(23例)和术后未出血组(197例)。分析电动吸切器腺样体切除术治疗慢性鼻窦炎的疗效,以及术后并发症发生情况。比较术后出血组和术后未出血组患者的临床资料,并分析患者术后出血的影响因素。通过Python 3.6软件,构建人工神经网络模型,并对模型的效能进行验证。结果 观察组治疗慢性鼻窦炎的总有效率明显高于对照组,差异有统计学意义(χ²=4.46,P=0.035)。观察组术后出血率、腺样体残留率和并发症总发生率明显低于对照组,差异均有统计学意义(χ²=8.90,P=0.003;χ²=8.43,P=0.00...