不同手术方式对治疗儿童阻塞性睡眠呼吸暂停低通气综合征效果分析

Analyzing therapeutic effects of different kinds of operations in children with obstructive sleep apnea hypopnea syndrome

目的:比较扁桃体剥离术加改良腭咽成形术及鼻内镜下腺样体切除术与单纯扁桃体摘除、腺样体刮除术对于儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopea syndrome,OSAHS)的手术并发症、治疗效果的差异,探讨不同手术方式及技巧对OSAHS的治疗效果。方法:选取OSAHS患儿78例,随机分为传统手术组与改良手术组;传统手术组患儿(40例)采用单纯扁桃体摘除、腺样体刮除术;改良手术组患儿(38例)采用扁桃体剥离术加改良腭咽成形术及鼻内镜下腺样体切除术。比较两组患儿的手术时间、术中出血量、术后6个月多道睡眠呼吸监测(PSG)指标、咽痛、腺样体残留、咽鼓管损伤及术腔愈合情况进行统计学分析。结果:两组患儿手术时间无明显差异(P>0.05);术中出血量改良组较传统组少,差异有统计学意义(P<0.05);术后6个月最低血氧饱和度改良组明显高于传统组,差异有统计学意义(P<0.05);术后出血、腺样体残留、咽痛及咽鼓管损伤及切口愈合时间等改良组较传统组少,均存在统计学差异(P<0.05)。结论:改良手术组患儿较传统手术组能显著降低儿童OSAHS患儿的并发症发生,改善预后,效果好,值得进一步的临床推广。

Objective： To compare differences of operative complications and therapeutic effects of tonsillectomy plus modified palatopharyngoplasty and nasal endoscopic adenoidectomy and simple tonsillectomy and adenoidectomy in treatment of children with obstructive sleep apnea hypopnea syndrome（ OSAHS）,and explore the therapeutic effect of different operation techniques on OSAHS.Methods： 78 cases diagnosed with OSAHS were randomly divided into traditional operation group（ performing simple tonsillectomy and adenoidectomy） and modified operation group（ doing tonsillectomy plus modified palatopharyngoplasty with nasal endoscopic adenoidectomy）. The operative time,intraoperative bleeding volume,index of polysomnography（ PSG）,pharyngalgia,residual adenoids incidence,injury of eustachian tube,and cavity healing conditions of the two groups were compared and statistically analyzed. Results：There was no significant difference in the operative time between the two groups（ P〉0. 05）; however,there were statistical differences in the postoperative bleeding volume,residual adenoids incidence,injury of eustachian tube,and cavity healing time between the two groups（ P〈0. 05）. Six months after the operation,the lowest oxygen saturation significantly increased（ P〈0. 05）. Conclusions：Compared with the traditional operation,tonsillectomy plus modified palatopharyngoplasty with nasal endoscopic adenoidectomy can reduce the surgical complication,improve the prognosis,enhance the treatment effect,and is worthy of the further clinical application.