Werle Andreas H, Nicklaus Pamela J, Kirse Daniel J, Bruegger Daniel E
Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City 66160, USA.
Int J Pediatr Otorhinolaryngol. 2003 May;67(5):453-60. doi: 10.1016/s0165-5876(02)00387-7.
To retrospectively review the experience with tonsillectomy in the under 2-year-old child at an urban children's hospital.
The medical records of 94 patients under 2 years old undergoing tonsillectomy between May 1, 1995, and May 31, 2000, were reviewed. The methods of tonsil and adenoid excision were noted, as was the use of perioperative steroids, antibiotics, and antiemetics. Outcome measures studied included the duration of postoperative inpatient observation, complications, time to first oral intake, prevalence of postoperative vomiting, type and duration of respiratory support, and improvement relative to operative indications.
Eighty-two patients (87%) underwent tonsillectomy and adenoidectomy (T&A). Twelve patients (13%) underwent tonsillectomy without adenoidectomy. Patient ages ranged from 12 to 23 months (mean 19.6+/-3.1). Indications included obstructive sleep apnea (OSA) in 51 patients (54%), chronic or recurrent tonsillitis in 30 (32%), both OSA and infection in 11 (12%), and acute tonsillitis with airway obstruction in two (2%). Comorbid conditions were numerous. Preoperative polysomnograms were obtained for eight patients (8%). Hospital stays ranged from 4 h to 16 days. Complications included hemorrhage in four patients (4%) and pneumonia in two (2%). Oxygen was required after discharge from the recovery room in 27 patients (29%), with seven more (7%) requiring either reintubation, continuous positive airway pressure, or nasopharyngeal airways. Of the 88 patients on oral diets, only five (5%) took longer than 24 h to resume oral intake. Two patients (2%) experienced significant emesis after surgery. Four patients (4%) required treatment for dehydration after discharge.
Tonsillectomy is a procedure with low morbidity in the otherwise healthy child under 2 years of age. However, we advocate routine postoperative overnight inpatient observation in this age group. We found that young children with comorbid conditions had a higher incidence of complications and required special postoperative management strategies.
回顾性分析一家城市儿童医院对2岁以下儿童行扁桃体切除术的经验。
回顾1995年5月1日至2000年5月31日期间94例2岁以下接受扁桃体切除术患儿的病历。记录扁桃体和腺样体切除方法，以及围手术期类固醇、抗生素和止吐药的使用情况。研究的结果指标包括术后住院观察时间、并发症、首次经口进食时间、术后呕吐发生率、呼吸支持类型和持续时间，以及相对于手术指征的改善情况。
82例（87%）患儿接受了扁桃体切除术和腺样体切除术（T&A）。12例（13%）患儿仅接受了扁桃体切除术。患儿年龄为12至23个月（平均19.6±3.1个月）。手术指征包括51例（54%）阻塞性睡眠呼吸暂停（OSA）、30例（32%）慢性或复发性扁桃体炎、11例（12%）OSA合并感染，以及2例（2%）急性扁桃体炎伴气道阻塞。合并症众多。8例（8%）患儿术前行多导睡眠图检查。住院时间从4小时至16天不等。并发症包括4例（4%）出血和2例（2%）肺炎。27例（29%）患儿在从恢复室出院后需要吸氧，另有7例（7%）需要再次插管、持续气道正压通气或使用鼻咽气道。88例经口进食的患儿中，只有5例（5%）恢复经口进食的时间超过24小时。2例（2%）患儿术后出现严重呕吐。4例（4%）患儿出院后需要治疗脱水。
对于2岁以下身体健康的儿童，扁桃体切除术的发病率较低。然而，我们主张对该年龄组患儿术后进行常规过夜住院观察。我们发现，合并症患儿的并发症发生率较高，需要特殊的术后管理策略。
