鼻内镜下腺样体形态学研究及临床意义

目的探讨腺样体随年龄的增长发展、退化、消失的演变过程，以及其肥大的临床意义及组织病理学特点。方法采用鼻内镜技术对2～87岁有鼻阻塞及相关症状门诊患者2650例，3～85岁健康对照810例腺样体形态进行研究。根据鼻内镜下腺样体的大小分为0～Ⅲ度记录。镜下取腺样体组织活检病理学检查39例。结果患者组2—9岁年龄段高度肥大型（Ⅲ度）、轻中度肥大型（Ⅱ度）腺样体分别占81．1％（198／244）、18．9％（46／244），其中2～5岁66例患儿腺样体均为Ⅲ度；10岁以上各年龄段腺样体从以Ⅱ度为主逐渐向Ⅰ度萎缩型和0度消失型过渡。60～69岁腺样体消失（0度）占多数（66．5％），81岁以上达100％。腺样体消失出现的最小年龄（19岁）和Ⅲ度肥大腺样体出现的最大年龄（21岁）均发生在20岁左右。健康组各度腺样体所占比例与患者组比较，除2～9岁年龄段差异有统计学意义外Ⅲ度占57．9％（22／38），Ⅱ度占42．1％（16／38），x^2=10．373，P〈0.01]，其余各年龄段差异无统计学意义。鼻内镜下观察Ⅲ度腺样体阻塞后鼻孔的部分其外观类似于肥大的腭扁桃体，Ⅱ度形态多样，Ⅰ度基本形态为橘瓣状。组织病理学上儿童腺样体淋巴组织丰富，成人腺样体淋巴组织渐变分散而炎性反应明显。患者组各度腺样体中鼻窦炎和鼾症的发病率以Ⅲ度为高，分别为47．4％和18．7％，差异有统计学意义（x^2值分别为51.28和40.26，P值均〈0．01）。结论10岁以下儿童腺样体体积最大，低龄儿童，尤其是5岁以下儿童异常肥大的腺样体容易造成后鼻孔阻塞；10岁以后其腺样体呈萎缩趋势，对于20岁以上患者高度肥大的“腺样体”应注意与肿瘤相鉴别。

Morphological study of adenoid by endoscopy and its clinical significance

OBJECTIVE: To observe the natural process of adenoid growth and degeneration as the age grows, to investigate the related clinical significance and pathologic characteristics of hypertrophied adenoid. METHODS: Totally 2650 (age 2 to 87) cases with nasal obstruction or/and other symptoms were included in the patients group, and 810 (age 3 to 85) subjects without symptoms were included as the control group. Morphological characteristics examined with nasal endoscope. Biopsy was performed for 39 cases. The adenoid was calcified as 4 degrees according to the size. RESULTS: In the patient group, age 2 to 9, degree III and degree II adenoid were 81.1% (198/244) and 18.9% (46/244) respectively. And adenoid of children whose age 2 to 5 was 100.0% in degree III; In above 10 years old group, the adenoid was mostly degree II. In age 60 to 69 group, degree 0 was (66.5%), and in age 81 or above, degree 0 reaches 100%. And 19 years old was the youngest age at which adenoid of degree 0 started to be found and 21 was the oldest age at which there is no adenoid of degree III. In the control group, compared with the patient group, no statistical significant difference found in all other groups except in age 2 to 9 (degree III 57.9%, 22/38, degree II 42.1%, 16/38). Shapes of adenoids at degree II varied while degree I were almost like peeled orange. Pathologically, among children there are abundant of adenoidal lymph tissue, while in adults the lymph tissue getting less as age grows but with evident inflammation reaction. Among patients, the incidence of sinusitis and snoring was higher in degree III group compared with others, 47.4% and 18.7% respectively, and the differences is statistically significant (chi2 = 51.28, P < 0.01; chi2 = 40.26, P < 0.01). CONCLUSIONS: Adenoid volume of children (age < 10) is the biggest, especially of children under