儿童阻塞性睡眠呼吸暂停低通气综合征的手术治疗

目的：探讨手术治疗儿童阻塞性睡眠呼吸暂停低通气综合征的临床特征及疗效分析。方法：经多导睡眠监测确诊的OSAHS儿童32例，采用全麻下扁桃体切除和经口内窥镜下腺样体切除术治疗，并随访观察手术疗效，分析扁桃体、腺样体肥大与睡眠呼吸低通气指数（AHI）的相关性，进行手术前后的睡眠监测有关参数的比较。结果：腺样体厚度与鼻咽通气道的比值(AN值) 和扁桃体厚度与咽腔宽度的比值 (TP值)与AHI成正相关；所有手术的患儿围手术期没有出现急性呼吸道阻塞及术后出血、感染的情况，随访12～24个月，睡眠打鼾、张口呼吸等症状得到明显改善，没有鼻咽粘连、腺样体残留、咽鼓管功能障碍等并发症；手术后睡眠呼吸暂停及低通气指数、最低血氧饱和度和最长呼吸暂停低通气时间均比手术前有显著好转。结论：扁桃体与腺样体肥大是儿童OSAHS的主要原因，切除肥大的扁桃体和（或）腺样体是治疗儿童OSAHS的有效办法，经口内窥镜下腺样体切除术，具有直视、彻底和避免损伤周围附近重要结构的优点。

Surgical treatment on pediatric obstruction sleep apnea hypopnea syndrome

Objective: To study the clinical features and surgical curative effect of pediatric obstruction sleep apnea hypopnea syndrome(OSAHS). Methods: Thirty-two cases of pediatric OSAHS, diagnosed by overnight polysomnograph (PSG) were given trans-oral endoscopy-assisted adenoidectomy and/or tonsillectomy. Correlation between the relative sizes of adenoid (AN ratio), tonsils （TP ratio ）and apnea hypopnea index(AHI) were analyzed respectively, and parameters in PSG were compared between pre-and post-operation. Results: AN ratio and TP ratio were positively correlated to AHI. There were no acute obstructions in the airway and no post-operative bleeding and infections in any of the cases during peri-operation. Following up for 12 to 24 months postoperatively, snoring and open-mouth breathing released, and no nasopharyngeal adherence, residual adenoid or eustachian tube dysfunction were found. AI, AHI, the lowest oxygen saturation and the longest time of apnea and hypopnea were improved significantly after the operation. Conclusion: Adenoids and tonsil hypertrophy are major contributions to pediatric OSAHS, and adenoidectomy and/or tonsillectomy are the effective treatments. Trans-oral endoscopy-assisted adenoidectomy has the advantages as good visualization, complete removal and minimal damage.