扁桃体下极被膜保留的扁桃体切除术在儿童阻塞性睡眠呼吸暂停治疗中的应用

Application of coblation tonsillectomy with inferior pole capsule preservation in pediatric obstructive sleep apnea patients

摘要:

目的 观察扁桃体下极被膜保留的扁桃体切除术在儿童阻塞性睡眠呼吸暂停(OSA)中的可行性及优势。方法 将2018年8月—2019年12月行扁桃体下极被膜保留扁桃体切除术(91例)与2017年1月—2018年7月行传统扁桃体切除术(100例)治疗儿童OSA患者的临床资料进行回顾性对比分析。比较两组手术时间、术中出血、术后疼痛评分、术后并发症、随访1年的情况。结果 两组手术时间及术中出血无明显差异，下极被膜保留组术后第1天、第3天疼痛评分显著低于传统手术组(P＜0.05)。术后出血率传统手术组(7/100，7％)高于下极被膜保留组(2/91，2.19％)(P＜0.05)。术后随访1年，两组均未出现局部感染及再发扁桃体肥大情况。结论 扁桃体下极被膜保留的扁桃体切除术是儿童OSA的一种安全可行的手术方式，可以有效降低术后出血风险及术后疼痛。

关键词:扁桃体切除术;阻塞性睡眠呼吸暂停;儿童;术后出血;手术方式

Abstract:

Objective To observe the feasibility and advantages of coblation tonsillectomy with inferior pole capsule preservation in pediatric obstructive sleep apnea (OSA) patients.Methods A retrospective study was performed on 91 patients who underwent coblation tonsillectomy with inferior pole capsule preservation (inferior pole capsule preservation group) from August 2018 to December 2019 and 100 patients who received routine coblation tonsillectomy (routine group) from January 2017 to July 2018 for OAS in children. The operation time, intraoperative bleeding, postoperative pain score, postoperative complications and 1-year follow-up results were compared between the two groups.Results There were no statistical differences in the operation time and intraoperative bleeding between the two groups. The pain scores in the inferior pole capsule preservation group on postoperative day 1 and day 3 were lower than those in the routine group (P＜0.05). The postoperative bleeding rate in the routine group (7/100, 7%) was higher than that in the inferior pole capsule preservation group (2/91, 2.19%) (P＜0.05). During 1-year follow-up, no local infection and recurrent tonsillar hypertrophy were observed in both groups.Conclusion Tonsillectomy with inferior pole capsule preservation is a safe and effective surgical method for children with OSA, which can effectively reduce the risk of postoperative bleeding and postoperative pain.

Key words:Tonsillectomy;Obstructive sleep apnea;Child;Postoperative bleeding;Surgical technique