扁桃体腺样体切除术在亚洲儿童阻塞性睡眠呼吸暂停/低通气综合征治疗中的病例对照研究(英文)

Efficacy of tonsillectomy and adenoidectomy in Asianchildhood obstructive sleep apnea/hypopnea syndrome:a case control study

目的评价扁桃体、腺样体切除术对伴有其他上气道疾病的儿童阻塞性睡眠呼吸暂停/低通气综合征(OSAHS)的疗效。方法回顾性总结香港大学附属根德夫人儿童医院睡眠中心1999年5月至2003年5月的儿童OSAHS病例资料。依据睡眠监测结果诊断OSAHS,再根据体格检查及鼻咽侧位片结果确定这些OSAHS患儿是否存在扁桃体、腺样体肥大。将有扁桃体、腺样体肥大的OSAHS患儿分成手术治疗组和对照组,两组随访观察12个月。对术后仍有OSAHS表现的病例行睡眠内窥镜检查寻找原因。结果88例儿童中,61例诊断为OSAHS,其中39例伴有扁桃体、腺样体肥大,25例接受扁桃体、腺样体切除术治疗。在接受手术治疗的患儿中,手术后随访时氧减指数及最低血氧饱和度较手术前得到显著改善。治疗组中24%随访时仍有OSAHS的表现,而对照组85%的患儿OSAHS表现仍持续存在(OR=15.4,95%置信区间为2.7～87.5)。手术后仍有OSAHS表现的主要原因是肥胖、骨软骨发育不良、上气道解剖结构异常以及维持气道开放的神经肌肉功能异常。结论扁桃体、腺样体切除术在扁桃体、腺样体肥大同时伴有其它上气道疾病的大部分亚洲OSAHS儿童中是有效的。由于上气道结构或维持气道开放的神经肌肉功能异常,可以导致手术后OSAHS症状的残存。对这些患儿,需要做进一步检查明确病因。

Objective To evaluate the efficacy of tonsillectomy and adenoidectomy （T＆A） in Asian childhood obstructive sleep apnea/hypopnea syndrome （OSAHS）. Methods The medical data of the OSAHS patients in the Sleep Center of the Duchess Kent Children＇s Habilitation Institute from May 1999 to May 2003 were retrospectively reviewed. OSAHS was diagnosed according to the abnormal sleep monitoring results. The clinical outcomes were followed up and compared between the Operation and Non-operation groups （Control） in OSAHS children with adenotonsillar hypertrophy （ATH）. Sleep endoscopy was performed for those who had residual OSAHS for the purpose of detecting the underlying causes. Results Sixty-one patients were diagnosed with OSAHS. Among the OSAHS patients, 39 were associated with ATH, and 25 of the 39 patients underwent T＆A. The desaturation dip rate and minimum saturation in the Operation group were significantly improved after T＆A. Six out of 25 （24%） patients in the Operation group had residual OSAHS whereas 11 out of the 13 （ 85% ） patients in the Control group had unchanged or worsening clinical symptoms （ OR = 15.4, 95% CI 2.7-87.5）. Residual OSAHS after surgery were attributable to obesity, achondroplasia, upper airway structure anomaly and airway dynamic problems. Conclusions T＆A was effective in the majority of Asian childhood OSAHS associated with ATH. Upper airway structure or dynamic abnormalities can result in residual OSAHS in parts of children. Further investigation is required to detect the underlying problems.