儿童阻塞性睡眠呼吸暂停低通气综合征手术疗效分析

Effect of surgery on obstructive sleep apnea hyponea syndrome in children

目的探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)手术成功和失败的原因,以提高手术预评估水平,提高手术疗效。方法将我院2003年3月～2006年3月手术治疗的112例临床资料完整的OSAHS患儿进行疗效分析。其中,扁桃体加腺样体切除56例;单纯扁桃体切除41例,包括单侧扁桃体切除2例;单纯腺样体切除15例。结果治愈102例(91.1%),包括单侧扁桃体切除后对侧扁桃体代偿增生肥大者2例,再次行对侧扁桃体切除后治愈;显效9例(8.0%),包括肥胖4例,咽淋巴增生1例,鼻部阻塞4例;好转1例(0.9%),为肥胖伴下颌骨后缩者;无效0例。结论儿童OSAHS大多手术疗效较好,少数肥胖、鼻部阻塞、咽淋巴环增生及下颌后缩者疗效欠佳。在腺样体、扁桃体手术前同时应考虑解除其他部位阻塞或无创通气治疗,方可进一步提高手术疗效。对肥胖患儿还应加以减肥治疗。

OBJECTIVE To analyze the reasons of success or failure after surgery for pediatric patients with obstructive sleep apnea and hyponea syndrome（OSAFIS）, and to make a better preoperative assessment for improvement of the efficacy of the surgery. METHODS From March 2003 to March 2006, 112 cases of children with OSAHS were treated by surgery and their outcome were analyzed retrospectively. Among them, 56 cases were treated with tonsillectomy and adenoidectomy, 40 cases with simple tonsillectomy （including two cases of unilateral tonsillectomy） and 12 cases with simple adenoidectomy. RESULTS There were 102 patients （91.1%） cured, 9 cases （8.0 %） remarkable improved, 1 case （0.9 %） improved. There were two children who had undergone unilateral tonsillectomy were cured following contralateral tonsillectomy due to compensatory hypertrophy of the remaining tonsils. Among remarkable improvement cases, 4 children were with obesity, 1 with pharyngeal lymphoid hyperplasia and 4 with nasal obstruction. The case with improvement after surgery was found with mandibular retrusion. CONCLUSION Most children with OSAHS had a better surgical treatment outcome. Only few children with obesity, nasal obstruction, pharyngeal lymphoid hyperplasia and mandible retrusion had less effect relatively. Therefore surgery for other level obstruction and non-invasive ventilation should be considered for these children after adenoidectomy and tonsillectomy. Obese children should get a slimming treatment.