儿童阻塞性睡眠呼吸暂停低通气综合征的改良激光和消融治疗

目的 探讨二氧化碳激光腭扁桃体部分切除术(carbon dioxide laser tonsillotomy,CLTT)治疗儿童腭扁桃体肥大和鼻内镜下低温等离子射频消融术治疗儿童腺样体肥大的疗效.方法 对126例腺样体和腭扁桃体肥大的阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患儿行CLTT联合鼻内镜下低温等离子射频腺样体消融术,随访观察手术疗效和腭扁桃体残余组织的免疫功能.结果 手术前后血清免疫球蛋白含量比较差异无统计学意义(P＞0.05),术后3个月随访,病理证实腭扁桃体残体组织仍具有免疫功能;腺样体无复发、腭扁桃体残体未见再生;上呼吸道阻塞症状改善总有效率为97.6%,其中65例行PSG复查总有效率为95.4%.结论 CLTF联合鼻内镜下低温等离子射频腺样体消融术治疗儿童OSAHS简单、安全、有效,又可保留腭扁桃体的免疫功能.

Improved laser and ablation treatment for obstructive sleep apnea hypopnea syndrome in children

Objective To investigate the therapeutic effect of carbon dioxide laser tonsillotomy （CLTr） combined with endoscopic low temperature-controlled plasma radio-frequency ablation on the treatment of tonsillar hypertrophy and on adenoid hypertrophy in children. Methods One hundred and twenty-six obstructive sleep apnea hypopnea syndrome patients with pediatric palatine tonsilla and adenoid hypertrophy were treated with CLTT combined with endoscopic low temperature-controlled plasma radio-frequency ablation. The curative effect and the immune function of the tonsillar tag was followed up. Results The preoperative and postoperative serum level of immunoglobulin was not significantly different（P 〉0.05）. Three months after operation, the immune function of the tonsillar tag was confirmed by pathologic examination, no adenoid recurrence or the tonsillar tag regeneration was found. The total effective rate of improvement in the upper respiratory tract obstruction was 97.6%. Sixty-five patients accepted the polysomnography examination, with the total effective rate being 95.4%. Conclusions CLTr combined with endoscopic low temperature-controlled plasma adenoid radio-frequency ablation was a simple, safe and curative treatment for pediatric OSAHS, with the immune function of the palatine tonsil remained.