Wong Lillian, Moxham J Paul, Ludemann Jeffrey P
Department of Pediatric Otolaryngology, British Columbia's Children's Hospital, Vancouver, BC.
J Otolaryngol. 2004 Apr;33(2):104-6. doi: 10.2310/7070.2004.00104.
The technique of adenoidectomy has undergone many refinements over the years with, most recently, the addition of electrosurgery alone as a viable method for removal of adenoid tissue. Several studies have suggested good efficacy with this method. The objective of this study is to examine the effectiveness of adenoidectomy by electrosurgical ablation by the following measures: reduction of the adenoid size, blood loss, and postoperative complications.
In this prospective study, we reviewed patients who underwent electrosurgical adenoid ablation for either nasal obstructive symptoms or chronic otitis media with effusion requiring a second or greater set of pressure equalization tubes and adenoidectomy. Preoperative and postoperative videonasopharyngoscopy were performed and evaluated. A grading system for adenoid size for the endoscopic parameters was used. The amount of blood loss and postoperative complications were recorded.
On preoperative nasopharyngoscopy, 7 of 23 children had a grade II adenoid size, 15 of 23 had grade III adenoid pads, and 1 of 23 had grade IV adenoid size. Postoperative follow-up at 6 to 8 weeks revealed that 19 of 23 children showed no evidence of adenoid tissue. Three of 23 children had only tiny residual tissue that fell into grade I and one had regrowth of tissue to fit into grade III. Eight patients were seen at 6 months postoperatively, four of whom were followed up to 12 months postoperatively; all showed no evidence of regrowth of adenoid tissue. Average blood loss for the procedure was 2.6 cc. No postoperative complications (postoperative bleed, dehydration requiring hospitalization, infection, velopharyngeal insufficiency) were encountered.
Electrosurgical adenoid ablation is a safe method with minimal intraoperative blood loss and postoperative complications. Follow-up at 6 to 8 weeks and up to 1 year postoperatively suggests that it is an effective method in removing adenoid tissue and alleviating nasal obstruction.
多年来腺样体切除术技术有了许多改进，最近，单纯电外科手术已成为切除腺样体组织的一种可行方法。多项研究表明该方法疗效良好。本研究的目的是通过以下指标来检验电外科消融腺样体切除术的有效性：腺样体大小的缩小、失血量及术后并发症。
在这项前瞻性研究中，我们回顾了因鼻阻塞症状或慢性分泌性中耳炎需要插入第二套或更多套压力平衡管并进行腺样体切除术的患者，这些患者接受了电外科腺样体消融术。术前行鼻咽喉镜检查并评估，术后再次行鼻咽喉镜检查并评估。采用内镜参数腺样体大小分级系统，记录失血量及术后并发症情况。
术前鼻咽喉镜检查显示，23例儿童中7例腺样体大小为Ⅱ级，15例为Ⅲ级，1例为Ⅳ级。术后6至8周随访发现，23例儿童中有19例未见腺样体组织残留。23例儿童中有3例仅有微小残留组织，属于Ⅰ级，1例组织再生至Ⅲ级。术后6个月对8例患者进行了观察，其中4例随访至术后12个月；所有患者均未见腺样体组织再生迹象。该手术的平均失血量为2.6毫升。未出现术后并发症（术后出血、需住院治疗的脱水、感染、腭咽功能不全）。
电外科腺样体消融术是一种安全的方法，术中失血量少，术后并发症少。术后6至8周及长达1年的随访表明，它是一种切除腺样体组织和缓解鼻阻塞的有效方法。
