经口鼻内镜和间接喉镜下腺样体切除的比较

Comparison of adenoidectomy between two approaches by nasal endoscopy and by indirect laryngoscopy

目的比较经鼻内镜和间接喉镜辅助直视下切除腺样体两种方法的疗效。方法收集140例腺样体肥大的患儿,鼻内镜组(A组)75例、间接喉镜组(B组)65例;分别统计两组患儿术中出血量、恢复正常通气时间、疗效及术后并发症的发生情况,并行统计学分析。结果 A组75例中治愈52例,有效23例,有效率为100%;B组65例中治愈55例,有效10例,有效率为100%。分别比较两种术式术中出血量A组(19±4.1)ml,B组(18±4.6)ml、恢复通气时间A组(8±3.1)d,B组(7±3.1)d,差异无统计学意义(P>0.05)。另对术后2、4、12周各疗效指标行统计学分析,差异无统计学意义。术后鼻内镜检查:A组有3例(4%)腺样体残留;B组有7例(11%)腺样体残留;均发生在鼻咽顶与后壁交界处,对咽鼓管及鼻通气无影响。两种术式均无鼻咽闭锁或狭窄、饮水返流等手术并发症。结论经口间接喉镜下与鼻内镜下腺样体切除术的疗效均较满意,术中出血及并发症均无差异,选择哪一种术式,可根据各自的医疗条件决定。

Objective To compare the difference in adenoidectomy between by nasal endoscopy and by indirect laryngoscopy. Methods A total of 140 children with adenoidal hypertrophy were enrolled in the study. They were divided into Group A （ nasal endoscopy group, n = 75） and Group B （ indirect laryngoscopy group, n = 65）. The parameters such as intraoperative blood loss, time of restoring normal ventilation, and postoperative complication were analyzed. Results Group A, the numbers of cure and effectiveness were 52 and 23, with an effective rate of 100% ; in Group B, the counterparts were 55 and 10, also with an effective rate of 100%. There were no statistical differences in intraoperative blood loss and time of restoring normal ventilation between Group A and Group B（19.0 ±4.1 vs. 18.0 ±4.6 ml,8.0 ±.1 vs. 7.0±3.0 d） （P 〉0.05）. There were no statistical differences in other indexes in 2, 4 and 12 postoperative weeks. According to postoperative endoscopy, residual adenoids were found in 3 patients （4%） in Group A and in 7 patients （ 11% ） in Group B. All the residual adenoids didn＇ t bring forth influence on eustachian tube and nasal airway they were at either the roof or the posterior wall of nasopharynx. The two procedures led to no nasopharyngeal atre- sia or stenosis, regurgitation and other complications. Conclusion It is suggested that the two adenoidectomies by nasal endoscopy and by indirect laryngoscopy in month are both satisfactory. There are no differences in intraoperative blood loss, time of restoring normal ventilation and complication. And how to choose the procedure should be based on medical condition.