Lin Aaron C, Koltai Peter J
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
Otolaryngol Head Neck Surg. 2009 Jul;141(1):81-5. doi: 10.1016/j.otohns.2009.03.011.
To describe a new method and the indications for lingual tonsillectomy with endoscopy and coblation, and to document its utility for treating children with persistent obstructive sleep apnea after previous tonsillectomy and adenoidectomy.
Case series with chart review in a tertiary pediatric medical center.
Twenty-six patients aged 3 to 20 met the inclusion criteria of polysomnography-proven persistent obstructive sleep apnea after tonsillectomy and adenoidectomy, as well as diagnosis of lingual tonsillar hypertrophy made by flexible fiberoptic sleep endoscopy. Endoscopic-assisted coblation lingual tonsillectomies were performed between June 2005 and January 2008. Preoperative and postoperative nocturnal polysomnogram data were paired and analyzed statistically.
Statistically significant reductions in the respiratory distress index (RDI) were seen when preoperative and postoperative data were compared (mean, 14.7 vs 8.1). There were similar reductions in the number of obstructive apneas and hypopneas. The mean minimum O2 saturation did not change. Two patients in this series developed adhesions between the epiglottis and tongue base; there appeared to be no consequence for airway or feeding issues.
Endoscopic-assisted coblation lingual tonsillectomy is an effective technique for the treatment of lingual tonsillar hypertrophy causing persistent obstructive sleep apnea in some children.
描述一种使用内镜和低温等离子消融术进行舌扁桃体切除术的新方法及其适应证，并记录其在治疗扁桃体切除术和腺样体切除术后仍患有持续性阻塞性睡眠呼吸暂停的儿童中的效用。
在一家三级儿科医疗中心进行的病例系列研究及病历回顾。
26例年龄在3至20岁之间的患者符合纳入标准，即经多导睡眠图证实扁桃体切除术和腺样体切除术后存在持续性阻塞性睡眠呼吸暂停，以及通过柔性纤维光学睡眠内镜诊断为舌扁桃体肥大。2005年6月至2008年1月期间进行了内镜辅助低温等离子消融舌扁桃体切除术。对术前和术后夜间多导睡眠图数据进行配对并进行统计学分析。
比较术前和术后数据时，呼吸窘迫指数（RDI）有统计学意义的降低（平均值分别为14.7和8.1）。阻塞性呼吸暂停和呼吸不足的数量也有类似程度的减少。平均最低血氧饱和度没有变化。该系列中有2例患者会厌与舌根之间出现粘连；但似乎对气道或喂养问题没有影响。
内镜辅助低温等离子消融舌扁桃体切除术是治疗某些儿童因舌扁桃体肥大导致持续性阻塞性睡眠呼吸暂停的有效技术。
