Nelson Lionel M
Arch Otolaryngol Head Neck Surg. 2003 May;129(5):533-7. doi: 10.1001/archotol.129.5.533.
To evaluate the safety and efficacy of temperature-controlled radiofrequency tonsil reduction in the treatment of children with a sleep-related breathing disorder associated with tonsillar obstructive hypertrophy.
Prospective, nonrandomized, case series feasibility study of children meeting the criteria for tonsillectomy or adenotonsillectomy for the treatment of an obstructive sleep-related breathing disorder.
Community-based hospital. Patients Ten children, aged 4 to 13 years, presenting consecutively to a community-based otolaryngology practice with tonsillar or adenotonsillar obstructive hypertrophy implicated clinically in causing a sleep-related breathing disorder; their parents consenting to temperature-controlled radiofrequency tonsil reduction instead of surgical tonsillectomy. Intervention Temperature-controlled radiofrequency tonsil reduction, along with surgical adenoidectomy, if adenoids were present, under general anesthesia.
Tonsil size reduction, treatment morbidity, and symptom improvement with follow-up to 1 year. Baseline and 3-month posttreatment polysomnographic data were used.
There was a reduction in tonsil size at 1 year of 75.0% on average, without evidence of regrowth during the 1-year follow-up. All children were drinking liquids in the recovery room, and most were eating soft diets within 6 hours; 8 of the 10 children were eating a normal diet by day 5. On average, the return to normal activity was 3.9 days, with 2.9 days of parental loss of work time. Quality-of-life variables all improved. Snore indexes decreased by 88.6%. Polysomnography at 3 months revealed an 84.2% reduction in the apnea index and a 52.3% reduction in the apnea/hypopnea index. There were no complications.
Temperature-controlled radiofrequency tonsil reduction seems to be a safe, effective, and minimally morbid treatment for tonsil hypertrophy in children with obstructive sleep-related breathing disorders.
评估温控射频扁桃体缩小术治疗与扁桃体阻塞性肥大相关的儿童睡眠呼吸障碍的安全性和有效性。
对符合扁桃体切除术或腺样体扁桃体切除术标准以治疗阻塞性睡眠呼吸障碍的儿童进行前瞻性、非随机、病例系列可行性研究。
社区医院。患者10名年龄在4至13岁的儿童，连续到社区耳鼻喉科就诊，临床诊断为扁桃体或腺样体扁桃体阻塞性肥大导致睡眠呼吸障碍；其父母同意采用温控射频扁桃体缩小术而非手术扁桃体切除术。干预在全身麻醉下进行温控射频扁桃体缩小术，若存在腺样体则同时行手术腺样体切除术。
随访1年的扁桃体大小缩小情况、治疗发病率及症状改善情况。使用基线和治疗后3个月的多导睡眠图数据。
1年时扁桃体大小平均缩小75.0%，在1年随访期间无复发迹象。所有儿童在恢复室均能饮用液体，多数在6小时内开始进食软食；10名儿童中有8名在第5天恢复正常饮食。平均恢复正常活动时间为3.9天，父母误工时间为2.9天。生活质量变量均有改善。打鼾指数下降88.6%。治疗后3个月的多导睡眠图显示呼吸暂停指数下降84.2%，呼吸暂停/低通气指数下降52.3%。无并发症发生。
温控射频扁桃体缩小术似乎是治疗阻塞性睡眠呼吸障碍儿童扁桃体肥大的一种安全、有效且发病率极低的治疗方法。
