儿童圆枕增生外科处理的初步探讨

Preliminary experience of surgical treatment for torus tubarius hypertrophy in children

目的:探讨复发性阻塞性睡眠呼吸暂停(OSA)患儿中圆枕增生的发生情况及外科处理的初步经验。方法:回顾性分析2004年1月至2020年2月在解放军总医院第四医学中心耳鼻咽喉头颈外科接受腺样体和/或扁桃体切除术治疗的4 922例儿童OSA患者的临床资料,其中男3 266 例,女1 656 例;年龄1~14 岁(中位年龄5岁);筛选在我院或外院接受过腺样体和/或扁桃体手术,因症状复发而再次就诊病例22例,详细记录上述患儿性别、首次手术年龄、症状复发年龄及发病情况及手术方式。采用门诊复诊及电话随访相结合的方式进行随访。应用GraphPad Prism 5.0软件进行统计学分析。结果:4 922例儿童OSA患者中,因症状复发需要再次手术的病例共计22例,其中11例为圆枕增生,占全部病例的2.23‰(11/4 922);1例咽鼓管圆枕瘢痕增生黏连,占全部病例的0.20‰(1/4 922);10例为残留腺样体增生+管扁桃体肥大,占全部病例的2.03‰(10/4 922)。11例圆枕增生病例接受腺样体和/或扁桃体手术治疗的年龄为2.4~6.0岁(中位数3.0岁),症状复发时间为术后2个月~5.5年[(2.4±1.9)年],接受圆枕部分切除术的年龄在4.0~12.0 岁[(7.0±2.7)岁];2 次手术时间间隔0.5~6.0年[(3.5±2.1)年]。采用低温等离子技术以圆枕部分切除术为基本术式制订个性化治疗方案,所有病例治疗效果良好,均未发生鼻咽狭窄并发症。随访时间1.6~13.0年(中位随访时间6.2年),22例病例随访率100%。结论:圆枕增生为腺扁术后OSA症状复发的原因之一,且易与管扁桃体肥大混淆;低温等离子辅助圆枕部分切除术安全、有效。

Objective To assess the incidence of symptomatic torus tubarius hypertrophy(TTH)in recurred OSA in children,and to explore the preliminary experience of partial resection of TTH assisted with radiofrequency ablation.Methods From January 2004 to February 2020,4922 children,who diagnosed as OSA and received adenotonsillectomy at the Department of Otolaryngology,The 4th Medical Center of the PLA General Hospital,were retrospectively reviewed.There were 3266 males and 1656 females,the age ranged from 1 to 14 years old(median age of 5.0 years).Twenty-two cases were identified with recurrence of OSA syndrome,and the clinical data,including sex,age of primary operation,age of recurrence and presentation,and opertation methods were analyzed.Follow-up was carried out by outpatient visit or telephone.Graphpad prism 5.0 software was used for statistical analysis.Results Twenty-two cases were identified as recurred OSA and received revised surgery in 4922 cases.Among these 22 cases,11 cases were diagnosed as TTH resulting in an incidence of 2.23‰(11/4922),1 case was cicatricial adhesion on tubal torus(0.20‰,1/4922),10 cases were residual adenoid combined with tubal tonsil hypertrophy(2.03‰,10/4922).Median age of primary operation was 3.0 years(range:2.4 to 6.0 years)in 11 TTH cases.Recurrent interval varied from 2 months to 5.5 years(2.4±1.9 years)after first operation.Age of revised partial resection of TTH was 7.0±2.7 years(range:4.0 to 12.0 years).Average time interval between primary operation and revised operation was 3.5±2.1 years(range:0.5 to 6.0 years).Individualized treatments were carried out based on partial resection of TTH assisted with radiofrequency ablation.All of 11 cases received satisfied therapeutic results without nasopharyngeal stenosis occured.Twenty-two cases were followed up for 1.6 to 13 years(median follow-up time was 6.2 years).Conclusions TTH contributed to recurred OSA in child.TTH might be misdiagnosed as tubal tonsil hypertrophy.Partial resection of TTH assisted with radiofrequency ablation was a safty and effective treatment.