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目的评价扁桃体、腺样体切除术对伴有其他上气道疾病的儿童阻塞性睡眠呼吸暂停/低通气综合征(OSAHS)的疗效。方法回顾性总结香港大学附属根德夫人儿童医院睡眠中心1999年5月至2003年5月的儿童OSAHS病例资料。依据睡眠监测结果诊断OSAHS,再根据体格检查及鼻咽侧位片结果确定这些OSAHS患儿是否存在扁桃体、腺样体肥大。将有扁桃体、腺样体肥大的OSAHS患儿分成手术治疗组和对照组,两组随访观察12个月。对术后仍有OSAHS表现的病例行睡眠内窥镜检查寻找原因。结果88例儿童中,61例诊断为OSAHS,其中39例伴有扁桃体、腺样体肥大,25例接受扁桃体、腺样体切除术治疗。在接受手术治疗的患儿中,手术后随访时氧减指数及最低血氧饱和度较手术前得到显著改善。治疗组中24%随访时仍有OSAHS的表现,而对照组85%的患儿OSAHS表现仍持续存在(OR=15.4,95%置信区间为2.7～87.5)。手术后仍有OSAHS表现的主要原因是肥胖、骨软骨发育不良、上气道解剖结构异常以及维持气道开放的神经肌肉功能异常。结论扁桃体、腺样体切除术在扁桃体、腺样体肥大同时伴有其它上气道疾病的大部分亚洲OSAHS儿童中是有效的。由于上气道结构或维持气道开放的神经肌肉功能异常,可以导致手术后OSAHS症状的残存。对这些患儿,需要做进一步检查明确病因。
Objective To evaluate the efficacy of tonsillectomy and adenoidectomy for obstructive sleep apnea / hypopnea syndrome (OSAHS) in children with other upper airway diseases. Methods The data of OSAHS in children from May 1999 to May 2003 were retrospectively reviewed in the Sleep Center of Children’s Hospital affiliated to the University of Hong Kong. OSAHS was diagnosed based on the results of sleep monitoring, and the presence of tonsil and adenoid hypertrophy was determined in children with OSAHS based on physical examination and nasopharyngeal radiographs. Will have tonsils, adenoid hypertrophy in children with OSAHS divided into surgical treatment group and control group, two groups were followed up for 12 months. Looking for reasons for sleep endoscopy in patients who still have OSAHS after surgery. Results Of the 88 children, 61 were diagnosed as OSAHS, of which 39 were associated with tonsil, adenoid hypertrophy, and 25 were treated with tonsillectomy and adenoidectomy. In children undergoing surgery, oxygen reduction index and minimum oxygen saturation at follow-up were significantly improved compared with those before surgery. OSAHS was still observed in 24% of the treated patients in the treatment group, while 85% of the controls in the control group continued to have OSAHS (OR = 15.4, 95% confidence interval, 2.7 to 87.5). The main causes of OSAHS after surgery are obesity, osteochondral dysplasia, abnormalities in the anatomy of the upper airways, and neuromuscular dysfunction in maintaining airway opening. Conclusions Tonsils and adenoidectomy are effective in the majority of OSAHS Asian children with tonsillitis, adenoid hypertrophy and other upper airway diseases. Due to the upper airway structure or to maintain the airway open neuromuscular dysfunction, can lead to postoperative OSAHS symptoms remain. For these children, need to do further examination of a clear cause.