低温射频消融扁桃体与腺样体治疗儿童OSAHS的疗效观察(1)
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[摘要] 目的 探讨低温等离子射频消融扁桃体与腺样体肥大治疗儿童OSAHS的临床疗效和安全性。方法 对2007年2月～2011年4月78例6～16岁符合OSAHS诊断标准的扁桃体和(或)腺样体肥大的儿童，行扁桃体和(或)腺样体低温等离子射频消融治疗，观察其疗效情况。结果 所有病例中65例术后6个月复查PSG均提示AHI较术前明显降低，最低血氧饱和度较术前明显升高，差异有统计学意义(P<0.05)。结论 低温等离子射频消融扁桃体和(或)腺样体治疗儿童OSAHS安全有效。
[关键词] 儿童OSAHS；扁桃体肥大；腺样体肥大；低温等离子射频消融
[中图分类号] R 72 [文献标识码] B [文章编号] 1673-9701(2011)31-55-03
Therapentic Effect of Tonsillectomy and Adenoidectomy by Temperature-controlled Radiofrequency Ablation in Children Obstructive Sleep Apnea Hypoprea Syndrome
XU Shile HU Jianwen CHEN Weijun
ENT Department of Wenzhou No.2 People’s Hospital，Wenzhou 325000，China
[Abstract] Objective To explore the clinical effect and safety of temperature-controlled radiofrequency ablation of tonsil and adenoids in the treatment of children obstructive sleep apnea hypoprea syndrome(OSAHS). Methods From February 2007 to April 2011，78 patients with tonsil hypertrophy or adenoidal hypertrophy confirmed OSAHS were treated by temperature-controlled radiofrequency ablation of tonsil and/or adenoids，then to explore the clinical effect. Results Six months after the operation，65 of the 78 patients，the mean of apnea hypopnea index(AHI) and lowest oxygen saturation(LSaO2) after the operation representing a marked improvement than per-operation.Ther e was significant difference(P<0.05) between them. Conclusion The temperature-controlled radiofrequency ablation of tonsil and/or adenoids is an effective and safe technique in the treatment of children OSAHS.
[Key words] Children OSAHS；Tonsil hypertrophy；Adenoidal hypertrophy；Temperature-controlled radiofrequency ablation
随着儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的研究，关于儿童OSAHS对其各系统的生长发育造成各种不良影响，近来越来越被临床医师所重视，其主要治疗方式是手术切除肥大的扁桃体和(或)腺样体。而传统的扁桃体剥离术及腺样体刮除术由于出血多、易残留以及易损伤邻近组织，已逐渐被新术式取代。而低温等离子射频消融治疗方法因其出血少、止血方便、操作准确以及损伤小，已越来越多的被应用于临床手术。我科于2007开始采用低温等离子射频消融肥大的扁桃体与腺样体治疗儿童OSAHS，目前已取得较好的疗效，现报道如下。
1 资料与方法
1.1 一般资料
选取我科2007年2月～2011年4月病例78例，其中男47例，女31例，年龄6～16岁，中位年龄13.83岁，病程1～3年，全部病例均伴有睡眠打鼾，伴(或)不伴张口呼吸、睡眠憋醒、鼻塞、耳闷等症状，所有病例术前均行多导睡眠监测(PSG)确诊OSAHS，其中单纯扁桃体肥大(Ⅱ～Ⅲ度)28例，单纯腺样体肥大23例，扁桃体肥大(Ⅱ～Ⅲ度)并发腺样体肥大27例，术前常规行咽部检查确定扁桃体属于病理性肥大，鼻咽侧位片或鼻咽部CT平扫、电子纤维鼻咽镜确定腺样体属于病理性肥大，扁桃体肥大手术指征以咽部检查扁桃体Ⅱ～Ⅲ度肿大及结合相关临床症状。腺样体肥大手术指征以电子纤维鼻咽镜下腺样体肥大堵塞后鼻孔达2/3以上，鼻咽部CT A/N>0.70[1]及结合相关临床症状 ......
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