Koempel J A, Solares C A, Koltai P J
Division of Otolaryngology, Children's Hospital of Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027, USA.
J Laryngol Otol. 2006 Dec;120(12):993-1000. doi: 10.1017/S0022215106002544. Epub 2006 Aug 21.
Within the last 10 to 15 years, a significant amount of research in tonsil surgery has focused on reduction of post-operative pain and recovery time. In order to minimize or avoid morbidity, a number of otolaryngologists in the United States and Europe have revived a historical procedure, previously known as 'tonsillotomy', specifically for those patients with obstructive sleep-disordered breathing (OSDB) due to adenotonsillar hypertrophy. More recently, surgeons have used terms such as partial tonsillectomy, partial intracapsular tonsillectomy or subtotal tonsillectomy to describe their procedure and have employed a variety of modern instrumentation. This return to a 'partial' procedure has generated a debate similar to that which occurred amongst tonsil surgeons about 100 years ago, when tonsillotomy was the most commonly performed procedure. Today, concerns about regrowth and problems with infection of the remaining tonsillar tissue have been raised. Such concerns, combined with an incomplete understanding of why the 'partial' procedure was abandoned in the early twentieth century, may explain why tonsil surgeons hesitate to change their approach to patients with OSDB due to adenotonsillar hypertrophy. These issues can be addressed in a meaningful way only through a detailed review of the evolution of tonsil surgery, which is presented here. This information, along with a summary of the last 10 years' experience with these techniques, supports the use of a 'partial' procedure in children with OSDB due to adenotonsillar hypertrophy. Future areas of research are also discussed.
在过去10到15年里，扁桃体手术的大量研究都集中在减轻术后疼痛和缩短恢复时间上。为了将发病率降至最低或避免发病，美国和欧洲的一些耳鼻喉科医生重新启用了一种历史上的手术方法，该方法以前称为“扁桃体切除术”，专门用于那些因腺样体扁桃体肥大而患有阻塞性睡眠呼吸障碍（OSDB）的患者。最近，外科医生使用了诸如部分扁桃体切除术、部分囊内扁桃体切除术或次全扁桃体切除术等术语来描述他们的手术，并采用了各种现代器械。这种回归“部分”手术的做法引发了一场类似于大约100年前扁桃体外科医生之间发生的争论，当时扁桃体切除术是最常用的手术方法。如今，人们对剩余扁桃体组织的再生和感染问题表示担忧。这些担忧，再加上对20世纪初为何放弃“部分”手术方法的不完全理解，可能解释了为什么扁桃体外科医生在面对因腺样体扁桃体肥大而患有OSDB的患者时，不愿改变他们的治疗方法。只有通过详细回顾扁桃体手术的演变过程，才能以有意义的方式解决这些问题，本文将对此进行阐述。这些信息，连同过去10年这些技术的经验总结，支持对因腺样体扁桃体肥大而患有OSDB的儿童采用“部分”手术方法。本文还讨论了未来的研究领域。
