单侧扁桃体切除术后对患儿生活质量及体液免疫功能的影响

Effect of unilateral tonsillectomy on quality of life and humoral immunity in children

目的探讨单侧扁桃体切除术对儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的II缶床治疗价值。方法将40例人院诊断为OSAHS的患儿分为两组：单侧扁桃体切除术（uT）组20例，双侧扁桃体切除（BT）组20例。术后随访6—18个月，以电子喉镜检查观察uT组患儿保留的扁桃体形态变化；用儿童OSAHS疾病特异性生活质量调查表（disea sespecific quality of life for children with obstructive sleep apnea 18 itemssurvey，OSA．18）评估两组患儿生活质量改善情况，检测外周血免疫球蛋白（IgA、IgG、IgM）的变化情况。结果①uT组有少数患儿保留的扁桃体出现了不同程度增生；②两组间同一时期OSA-18表总分比较差异无统计学意义（P〉0．05），但两组术后各时期总分较术前均明显下降，差异具有统计学意义（P〈0．05）；③两组术后6、12、18个月血清IgG、IgM、IgA的含量较术前变化微小，差异无统计学意义（P均〉0．05）；两组同一时期比较差异无统计学意义（P均〉0．05）。结论单侧扁桃体切除术后部分患者的保留侧扁桃体出现了代偿性增生，但单侧切除术同样能有效解除患者口咽气道的阻塞，显著改善患儿生活质量，对体液免疫功能无明显影响。

Objective To study the clinical value of unilateral tonsillectomy for children with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods 40 children with OSAHS were included in this study. All the children were evenly divided into two groups, unilateral tonsillectomy （UT） group and bilateral tonsillectomy （BT） group. All cases were followed up for 6 to 18 months postoperatively. Electronic laryngoscopy was performed in children of UT group to observe morphological changes of contralateral tonsillae. Improvement of life quality in both groups was evaluated with OSA- 18 and humoral immunologic indexes （including serum IgA, IgG, IgM ） were detected. Results （~） Compensatory hypertrophy of contralateral tonsillae to verious degrees occurred in minority of UT group. （~）The OSA-18 scores showed no significant difference between the two groups in the same period （P 〉 0.05）. Within both groups, the OSA-18 scores at 6, 12 and 18 months after operation were reduced significantly compared with those before operation （all P 〈 0.05 ）. （~）The humoral immunologic indexes （serum levels of IgA, IgG, IgM） at 6, 12, 18 months after operation were slightly changed in both groups compared with those before operation, but the differences were statistically insignificant （ all P 〉 0.05 ）. Meanwhile, the levels of serum immunoglobins showed no significant differences between the two groups at the same period （ all P 〉 0.05）. Conclusions Although hypertrophy of contrallateral tonsilla to varying degrees is compensatory, unilateral tonsillectomy still can effectively relieve obstruction of the oropharyngeal airway, and improve life quality of the patients significantly. Meanwhile, this operation doesn＇t affect the humoral immunological function and therefore can reassure the nervous parents.