小儿阻塞性睡眠呼吸暂停综合征的鼻咽部多层螺旋CT研究

The study of nasopharynx in children with suspected obstuctive apnea syndrome by mutislice spiral CT

目的:探讨多层螺旋CT(MSCT)对疑似小儿阻塞性睡眠呼吸暂停综合征(OSAS)的临床价值。方法:随机选取临床怀疑为OSAS的各年龄组儿童30名(Ⅰ组1～3岁,Ⅱ组4～8岁,Ⅲ组9～14岁),分别进行鼻咽部多层螺旋CT(MSCT)扫描及多导睡眠监测(PSG)。CT横断图像经薄层重建后传递至工作站行多平面重组(MPR),于正中矢状面测定腺样体的厚度(A)及鼻咽腔宽度(N),以腺样体鼻咽比率(A/N)反映腺样体大小。结果:以A/N比率≥0.71为腺样体病理性肥大为参考标准,CT诊断OSAS29例;经PSG证实OSAS33例,其中A/N比率≥0.71者24例,A/N比率<0.71者9例。CT与PSG疾病检出的符合率为72.7%。儿童腺样体肥大与OSAS的诊断无明显的相关性(r=-0.991,P>0.05)。33例各年龄组OSAS儿童的A/N比率分别为:0.73±0.04、0.75±0.04、0.72±0.03,非OSAS(单纯性鼾症)各年龄组的A/N比率分别为:0.52±0.06、0.54±0.05、0.51±0.05。各年龄组OSAS儿童与单纯性鼾症儿童的A/N比率有显著差异性(P<0.01)。CT显示并发症:伴分泌性中耳炎9例,副鼻窦炎21例,鼻甲肥大18例。结论:MSCT能准确测定OSAS儿童腺样体的大小、评价鼻咽腔阻塞的程度,并且可清楚地显示并发症。MSCT可广泛地运用于临床对疑似OSAS的普查、筛选。

Objectlve：To investigate the clinical value of mutislice CT（MSCT） to nasoptmrynx in children with suspected obstructive sleep apnea syndrome （OSAS） by tile clinc. Methods：30 children in each age group were chosen at random （Group Ⅰ 1 ～ 3 years, Group Ⅱ 4 ～ 8 years, Group Ⅲ9 ～ 14 years）. All the children were searmed by MSCT and monitored by polysomnography（PSG）, CT axial images of 90 children were reconstructed with thin slice, and then the data was transmitted to the workstation and reconstructed with mntiplannar （MPR）. The adenoid thinkness （A） and the width of nasopharynx cavity （N） were measured on the center slice of sagittal plane, the size of adnoid was judged by adenoidalnasopliaryngea ratio （A/N）. Results：26 chilldren were diagnosed as OSAS by CT because their A/N ratio was greater than 0.71 ;33 OSAS children were cortfimaed by PSG, the A/N ratio was greater than 0.71 in 24 eases, the A/N ratio was less than 0.71 in 9 cases. The corresponding rate between CT and PSG was 72.7% in detecting disease. There was no eorrelection between the extent of adenoid hypertrophy and the diagnosis of OSAS （ r = -0.991, P 〉 0.05）. The A/N ratio of 33 OSAS eases was 0.73±0.04, 0.75 ± 0.04,0.72± 0.03, respectively, the A/N ratio of simple snoring was 0.52 ± 0.06,0.54± 0.05,0.51 ± 0.05, respectively. There was significant difference between the OSAS and the simple snoring（ P 〈 0.01）. The complications included secretory media otitis in 9 cases, nososinatis in 21 cases, hypertrophic eonchae in 8 cases. Conclusion： MSCT can measure the size of adenoid accurately and assess the extent of obstructive nasopharynx cavity, meanwhile, can show eomplcations of OSAS. MSCT may be applied extensively to suruey and screen the disease of OSAS in children.