儿童阻塞性睡眠呼吸暂停低通气综合征

Treatment of pediatric obstructive sleep apnea hypopnea syndrome

目的探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS)患儿的治疗方法。方法经鼻内窥镜检查确认的患儿30例,扁桃体切除和(或)经口窥镜引导下腺样体刮除29例,1例保守治疗。结果围手术期无术后出血,急性呼吸道梗阻发生。随访6～12月,手术患儿无鼻咽闭锁,咽鼓管功能障碍,腺样体残留等并发症。1例保守治疗略有改善。结论手术切除引起上气道阻塞的肥大扁桃体和(或)腺样体是儿童OSAHS有效的治疗手段之一。鼻内窥镜检查有助于手术适应症的确定。经口内窥镜引导下腺样体刮除术具有直视下操作,视野清晰,切除彻底,可避免损伤周围重要结构的特点。

Objective To evaluate treatment options of pediatric obstructive sleep apnea hypopnea syndrome(OSAHS).Methods In this study,there are 30 confirmed pediatric obstructive sleep apnea hypopnea syndrome cases diagnosed by endoscopy.Among them.29 cases were treatedl by tonsillectomy or/and adenoidectomy directed by transonal endoscopy.one case was treated with other conservative therapy.Results During perioperation period,no postoperative bleeding or acute respiratory obstruction occurred.Follow-up sleep study was carried out 6～12 mouths postoperatively,no complications of velopharyngeal insufficiency,nasopharyngeal stenosis or residual adenoid were found 1 case was slightly improved treated with conservative therapy.Conclusions Surgical removal of upper airway obstruction caused by enlargment of tonsil and adenoid is one of the most effective treament for pediatric OSAHS.Endoscopy is helpful to confirm surgical indication.The adventages of transoral edoloscopy directed adenoidectomy are as follows:clear and direct visualization,complete removal,without damaging of the peripheval structwes.[