手术治疗106例儿童阻塞性睡眠呼吸暂停低通气综合征临床疗效及预后分析

Clinical efficacy and prognosis of 106 children with obstructive sleep apnea hypopnea syndrome after surgical treatment

目的探讨手术治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床疗效及预后。方法回顾性分析106例确诊为OSAHS并接受手术治疗患儿的临床资料,其中<3岁16例(15.1%)、3~6岁64例(60.4%)、>6岁26例(24.5%)。83例(78.3%)患儿行腺样体联合扁桃体切除术,23例(21.7%)行单纯腺样体切除术。术后门诊随访,随访期间对出现并发症的患儿联合儿科进行诊治。结果所有患儿手术均顺利,术后夜间睡眠情况较术前明显好转,3例患儿术后1 d出现发热(1例反复高热),经儿科抗感染、退热等处理后体温恢复正常。所有患儿术后随访12~20个月,平均(16.0±1.4)个月。术后12个月时,88例(83.0%)患儿治愈、13例(12.3%)好转、5例(4.7%)无效。术后6个月内<3岁患儿有1例复发,术后12个月<3岁患儿有5例复发(31.2%,5/16),而3~6岁、>6岁手术患儿无复发,差异有统计学意义(P均<0.05)。7例<3岁患儿在术后12个月内出现反复呼吸道感染,联合儿科随诊及抗感染、免疫调节等积极治疗后治愈。结论手术切除仍是儿童OSAHS的主要治疗手段,但应根据阻塞病因的不同选择相应术式;对3岁以下患儿应在评估风险及预后的情况下慎重手术;术后随访及相关并发症处理时应与儿科医师配合,以减少远期不良预后。

Objective To evaluate the clinical efficacy and prognosis of children with obstructive sleep apnea hypopnea syndrome(OSAHS)after surgical treatment.Methods Clinical data of 106 children with OSAHS were retrospectively analyzed,including 16 cases(15.1%)aged<3 years,64 cases(60.4%)aged 3-6 years,and 26 cases(24.5%)aged>6 years.Among them,83 cases(78.3%)underwent adenoidectomy combined with tonsillectomy and 23 cases(21.7%)underwent adenoidectomy alone.They were followed up in outpatients after operation,and children with complications were treated with pediatrics.Results All patients were operated smoothly,and their sleep at night was significantly better than that before operation.Fever occurred in 3 cases 1 day after operation(1 case with repeated high fever),and their body temperature returned to normal after pediatric anti-infection and antipyretic treatment.All patients were followed up for 12-20 months,with an average of(16.0±1.4)months.At 12 months after operation,88 cases(83.0%)were cured,13 cases(12.3%)were improved,and 5 cases(4.7%)were ineffective.Within 6 months after operation,1 recurrence was found in children aged<3 years;at 12 months after operation,5 recurrence cases(31.2%,5/16)were found in children aged<3 years,while no recurrence occurred in children aged 3-6 years or>6 years,showing significant difference(both P<0.05).Seven cases of children aged<3 years with recurrent respiratory tract infections within 12 months after operation were cured after combining the followup of pediatrics(anti-infection and immunoregulation treatment).Conclusion Surgical resection is still the main treatment for children with OSAHS,and appropriate operation should be selected according to different obstruction causes;children aged<3 years should be operated cautiously after the assessment of risk and prognosis;meanwhile,follow-up after operation and treatment of related complications should be jointly done with professional pediatricians to reduce long-term poor prognosis.