鼻内镜下用切割吸引刀治疗腺样体肥大与腺样体刮勺盲刮的比较

Comparison between nasal endoscopic suction cutter treatment of adenoidal hypertrophy and blind adenoid scraping by spatula

目的:分析切割吸引刀治疗腺样体肥大的术中创伤程度及其对术后通气功能的影响。方法:112例腺样体肥大患者随机分为观察组及对照组,各56例,对照组接受腺样体刮勺盲刮治疗,观察组接受切割吸引刀治疗,对比两组术后血清炎症因子、凋亡因子含量,鼻通气功能及肺功能指标差异。结果:观察组术后2d血清炎症因子白介素-4(IL-4)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、嗜酸性细胞阳离子蛋白(ECP)、重组人细胞间黏附因子-1(ICAM-1)含量低于对照组,血清凋亡因子生存素(survivin)、半胱氨酸天冬氨酸特异性蛋白酶-3(caspase-3)、可溶性凋亡相关因子(sFas)、可溶性凋亡相关因子配体(sFasL)含量低于对照组,差异均有统计学意义(P<0.05);观察组术后1周鼻通气功能参数双侧吸气总阻力(TIR)、双侧呼气总阻力(TER)、鼻吸气量差异比(NPRi)、鼻呼气量差异比(NPRe)水平低于对照组,双侧鼻腔吸气量(IC)、双侧鼻腔呼气量(EC)水平高于对照组,肺功能参数潮气量(VT)、每分通气量(MV)、峰流速(PIEF)、分段用力呼气流量(FEF25、FEF50、FEF75)水平高于对照组,差异均有统计学意义(P<0.05)。结论:切割吸引刀治疗腺样体肥大,对患者的通气功能改善作用卓著,同时具有小创伤的优势。

Objective： To analyze the wound degree during suction cutter treatment of adenoidal hypertrophy and its effect on postoperative ventilation function. Methods： A total of 112 patients with adenoidal hypertrophy were randomly divided into observation group and control group （n = 56）, control group received blind adenoid scraping by spatula, observation group received suction cutter treatment, and then differences in serum levels of inflammatory cytokines and apoptosis factors as well as nasal ventilation function and lung function indexes were compared between two groups of patients after treatment. Results：Inflammatory cytokines IL-4, IL 6, TNF-a, ECP and ICAM-1 content in serum of observation group 2 d after treatment were lower than those of control group, and apoptotie factors survivin, caspase-3, sFas and sFasL content in serum were lower than those of control group （P 〈0.05）; nasal ventilation function parameters TIR, TER, NPRi and NPRe levels of observation group 1 week after treatment were lower than those o{ control group while IC and EC levels were higher than those of control group, and pulmonary function parameters VT, MV, PIEF, FEF25, FEF50 and FEF75 levels were higher than those of con- trol group （P〈0.05）. Conclusions： Suction cutter treatment of adenoid hypertrophy outstandingly improves the patients＇ venti- lation function, and also has the advantage of small wound.