腺样体切除术治疗儿童鼻窦炎20例

儿童鼻窦炎较为常见，近年来发病率日趋升高，颇受社会重视。其中有相当一部分与腺样体肥大同时存在，其病因与腺样体有很大关系。我科近2年来以切除腺样体作为治疗儿童鼻窦炎的一种方式，取得了良好疗效，现报告如下。     

鼻内镜下扁桃体、腺样体切除术

腺样体肥大是引起儿童分泌性中耳炎、鼻窦炎和儿童鼾症的主要病因，长期不治疗可影响儿童的生长发育，且常合并有慢性扁桃体炎，故一经确诊应尽早手术切除。传统的手术方式存在切除不彻底、不易控制出血等缺点。近年来，我科对40例扁桃体炎及腺样体肥大患者行鼻内镜下切除术，取得满意效果。现报告如下。     

鼻内镜下儿童腺样体切除术

腺样体肥大是引起儿童分泌性中耳炎、鼻窦炎、阻塞性睡眠呼吸暂停的主要病因,长久不治还可导致颌面发育障碍及身体、智力发育迟缓。孙文海等等研究资料显示腺样体肥大是儿童常见病、多发病,在儿童中的发病率为9．9％～29．2％,好发于寒冷潮湿地区,5岁以上腺样体肥大患儿常并发慢性扁桃体炎,曲灵美等团研究资料显示手术切除肥大的扁桃体和腺样体是目前治疗儿童OSAS的首选方法。腺样体是咽淋巴环的重要组成部分,在正常生理情况下6-7岁时最大,青春期以后逐渐萎缩。     

儿童扁桃体与腺样体切除术后发热因素分析

目的 探讨儿童扁桃体和/或腺样体切除术后发热的相关因素,为手术治疗和护理提供参考.方法 收集408例因扁桃体和/或腺样体肥大引起阻塞性睡眠呼吸障碍(OSDB)行扁桃体和/或腺样体切除术患儿的相关资料,分析发热与术中出血量、性别、扁桃体腺样体大小、扁桃体炎史、鼻窦炎现状、手术时段、手术季节和手术部位的关系.结果 408例...     

经鼻和口进路腺样体切除术出血分析

腺样体肥大除了传统的刮除术外，鼻内镜下用动力切吸腺样体也是广泛采用的一种有效方法。后者的优点是整个手术过程可以在监视器下进行，术野暴露清楚，术中切除腺样体干净，还可防止损失周围解剖组织。尽管存在上述优点，但随着该手术方法的推广，术中和术后仍可能出现相关的并发症，特别是出血。通过国内文献检索，较少有针对腺样体出血的报道。我科2007—2008年行扁桃体切除术和（或）腺样体切除术272例，其中6例术中和术后发生腺样体出血，本文分析可能导致出血的原因，为避免此类并发症的发生提供借鉴作用。     

儿童慢性扁桃体炎腺样体肥大切除202例

对２０２例慢性扁桃体炎腺样体肥大的患儿行手术切除，随访１８０例，治愈率９０％。对其中４０例伴有明确睡眠呼吸暂停病史的患儿手术前后进行了血气分析，结果（ｘ±ｓ）表明：术前ｐＨ７．３３４±０．０１３、Ｐｃｏ２（ｋＰａ）６．０４±０．２６、Ｐｏ２（ｋＰａ）１０３８±０２０，术后ｐＨ７３８８±００１８、Ｐｃｏ２５３７±０１９、Ｐｏ２１２４１±０２４，统计学处理各项指标均有显著性差异（Ｐ＜０．０１）。作者认为慢性扁桃体炎腺样体肥大如有睡眠性呼吸暂停临床症状及并发症者应早期手术治疗。     

小儿扁桃体和腺样体切除术适应证的免疫学基础

现代免疫学揭示了扁桃体是免疫防御器官,对身体有保护作用.儿童期扁桃体的免疫防御作用比成年期重要得多.在7～8岁以前扁桃体对机体的免疫防御是必不可少的.出生时扁桃体很小,缺乏生发中心,但随着从母体获得抗体的消失,扁桃体和腺样体增大,到5～6岁由于感染的影响,其增大达最高峰,然后逐渐变小,到7～8岁时止.所以,幼年期扁桃体和腺样体肥大是正常现象,很可能是免疫活动的指标.所以对8岁以下的儿童切除扁桃体必须十分慎重,除非存在绝对适应证,如难以控制的频繁发作的咽峡炎或内脏并发病、败血病性咽峡炎、阻塞性肥大等.     

鼻内镜下腺样体切除术治疗儿童腺样体肥大72例

目的 总结鼻内镜直视下行腺样体切除治疗腺样体肥大的优点及疗效.方法 对72例患者均施行全麻下行鼻内镜下腺样体切除术.结果 术后未发生任何并发症,全部患儿术后回访1～3年,未见复发病例.结论鼻内镜下腺样体切除术治疗小儿腺样体肥大安全且疗效显著.     

Impact of tonsillectomy and adenoidectomy on child behavior

OBJECTIVE: To measure the impact of tonsillectomy and adenoidectomy (T&A) on children's behavioral and emotional problems using a standardized assessment. DESIGN: Prospective study. SETTING: Tertiary care children's hospital. PATIENTS: Thirty-six children, aged 2 through 18 years, with symptoms of nighttime snoring, observed apneas, and daytime mouth breathing and physical examination results demonstrating 3+ or 4+ tonsils scheduled for T&A. INTERVENTION: Parents completed a standard survey of their children's symptoms of sleep apnea and a standardized measure of children's competencies and problems, the Child Behavior Checklist for ages 2 through 3 years or 4 through 18 years, before T&A and 3 months postoperatively. MAIN OUTCOME MEASURE: The Child Behavior Checklist total problem score. RESULTS: The preoperative Child Behavior Checklist total problem score was consistent with abnormal behavior for 10 children (28%). After T&A (n = 15), only 2 scores were abnormal, but the change was not statistically significant. In contrast, the mean total problem score was 7.5 points lower after surgery (95% confidence interval, 5.1-9.7), indicating a significant decrease (P<.001, matched t test). CONCLUSIONS: This pilot study demonstrates a high prevalence (28%) of abnormal behavior in children undergoing T&A for chronic upper airway obstruction. Scores on a standardized measure of behavior improve following T&A, but larger studies with increased statistical power are needed to clarify the degree of improvement and its clinical importance.     

Laser tonsillectomy and adenoidectomy

The use of the laser for performing tonsillectomy and adenoidectomy has proved to be a very effective method in terms of reducing postoperative pain, bleeding, and operative time. With use of the laser, most patients can be treated on an outpatient basis. However, the treating physician must balance the medical gains against the increase in cost for laser use before embarking on this approach for patient care.     

Complications of tonsillectomy and adenoidectomy

This article deals with fatality rate, causes of death, bleeding, and appropriate measures to prevent or treat such complications. Immunologic disturbances, consequences of tissue trauma, and recurrences after surgery are discussed.     

Anesthesia for tonsillectomy and adenoidectomy

Despite advances in the anesthetic pharmacopeia and improved noninvasive monitoring techniques, subjective bias and individual clinical experience remain major determinants of individual practice. Medicolegal pressures have increased in recent years, as has the concept of shared responsibility for surgical and anesthetic complications. New standards of anesthesia monitoring and practice are evolving in response to the need for perioperative risk management and cost-effective surgical care. Continued vigilance and close communication between the otolaryngologist and anesthesiologist remain key elements for safe anesthetic practice.     

Post-operative haemorrhage in tonsillectomy and adenoidectomy in children

A second anaesthetic for bleeding after adeno-tonsillectomy in children represents a significant hazard. The true incidence of this complication is assessed for over 20,000 operations. The incidence of bleeding after adeno-tonsillectomy was found to be the sum of bleeding post-adenoidectomy and post-tonsillectomy. Bleeding post-adenoidectomy is at least as common as post-tonsillectomy and both occur most frequently within 12 hours of operation. No reason for the bleeding occurring in these particular patients could be found.     

低温等离子刀辅助内镜下儿童扁桃体和腺样体切除术临床效果分析

目的:比较低温等离子刀辅助内镜下切除儿童扁桃体和腺样体(rT+A)和传统剥离法切除扁桃体、刮匙法刮除腺样体(cT+A)的手术效果差异.方法:47例扁桃体肥大伴腺样体肥大的患儿,其中24例采用rT+A术式,23例采用cT+A术式,采用t检验比较两组手术时间、术中出血量、术后疼痛时间和假膜脱落时间的差异.随访患儿手术前后听...