van Lierop Anton C, Prescott C A J, Fagan Johannes J, Sinclair-Smith Colin C
Division of Otorlaryngology, University of Cape Town, South Africa.
S Afr Med J. 2007 May;97(5):367-70.
The aims of the study were: (i) to determine the necessity for diagnostic tonsillectomy in children with asymmetrically enlarged tonsils; (ii) to determine the accuracy of clinical assessment of tonsillar asymmetry; and (iii) to determine how to manage children with clinical tonsillar asymmetry in a developing-world practice.
A prospective study was carried out at Red Cross War Memorial Children's Hospital in Cape Town, over an 8-month period. All children undergoing tonsillectomy or adenotonsillectomy had a clinical assessment of tonsil symmetry done, and all tonsil and adenoid specimens were examined histologically. The maximum diameter and volume of the resected tonsils were measured. A comparison was done of true tonsil asymmetry in patients with asymmetrical tonsils and a subgroup of matched controls with symmetrical tonsils.
A total of 344 tonsils were analysed (172 patients). The 13 patients (7.6%) diagnosed as having clinically asymmetrically enlarged tonsils had no significant pathological diagnosis. In the patients with symmetrical tonsils there were 2 abnormal pathological findings (tuberculosis of the adenoids and T-cell lymphoma of the tonsils and adenoids). In the clinically asymmetrical tonsil group, true tonsillar asymmetry was 3 mm (maximum diameter), and 2.2 cm(3) (volume), compared with 1.9 mm and 1.5 cm(3) in the symmetrical tonsil group. When patients with clinical tonsillar asymmetry and symmetry were compared, the difference in maximum diameter (p = 0.62) and volume (p = 0.73) was not significantly different.
Clinical tonsillar asymmetry is usually apparent rather than real. The incidence of significant pathology in children with asymptomatic, asymmetrical tonsils is low. Diagnostic tonsillectomy is indicated in children with asymmetrically enlarged tonsils associated with constitutional symptoms, cervical lymphadenopathy, rapid tonsil enlargement or significant tonsillar asymmetry.
本研究的目的是：（i）确定扁桃体不对称肿大儿童进行诊断性扁桃体切除术的必要性；（ii）确定扁桃体不对称临床评估的准确性；（iii）确定在发展中国家的医疗实践中如何处理临床扁桃体不对称的儿童。
在开普敦的红十字战争纪念儿童医院进行了一项为期8个月的前瞻性研究。对所有接受扁桃体切除术或腺样体扁桃体切除术的儿童进行扁桃体对称性的临床评估，所有扁桃体和腺样体标本均进行组织学检查。测量切除扁桃体的最大直径和体积。对扁桃体不对称患者和匹配的扁桃体对称对照组亚组的真正扁桃体不对称情况进行比较。
共分析了344个扁桃体（172例患者）。13例（7.6%）被诊断为临床扁桃体不对称肿大的患者没有显著的病理诊断。扁桃体对称的患者中有2例异常病理发现（腺样体结核以及扁桃体和腺样体的T细胞淋巴瘤）。在临床扁桃体不对称组中，真正的扁桃体不对称最大直径为3毫米，体积为2.2立方厘米，而对称扁桃体组分别为1.9毫米和1.5立方厘米。比较临床扁桃体不对称和对称的患者时，最大直径（p = 0.62）和体积（p = 0.73）的差异无统计学意义。
临床扁桃体不对称通常是表面的而非真实存在的。无症状、扁桃体不对称儿童中显著病理情况的发生率较低。对于伴有全身症状、颈部淋巴结病、扁桃体迅速肿大或明显扁桃体不对称且扁桃体不对称肿大的儿童，建议进行诊断性扁桃体切除术。
