Division of Otolaryngology, University of Cape Town Medical School.
S Afr Med J. 2009 Nov;99(11):805-9.
We aimed to determine the incidence of abnormal pathological findings in the tonsils and/or adenoids of children undergoing tonsillectomy and/or adenoidectomy, and the incidence of tuberculosis of the tonsils and adenoids; suggest criteria to identify children at risk for adenotonsillar tuberculosis; and investigate the association between HIV and adenotonsillar abnormality, the cost-effectiveness of routine pathological examination of adenotonsillectomy specimens, and criteria to decide which specimens to send for histological examination.
We undertook an 8-month prospective study on all children (< or =12 years) undergoing consecutive tonsillectomy or adenotonsillectomy (T&A) at Red Cross War Memorial Children's Hospital. Patients were assessed pre-operatively and tonsil sizes graded pre- and intra-operatively. Blood was taken for HIV testing, and all tonsils and adenoids were examined histologically. A cost-benefit analysis was done to determine the cost-effectiveness of adenotonsillectomy routine pathology.
A total of 344 tonsils were analysed from 172 children (102 boys, 70 girls); 1 patient had nasopharyngeal tuberculosis, and 1 lymphoma of the tonsils; 13 (7.6%) patients had clinically asymmetrically enlarged tonsils but no significant abnormal pathological finding. The average cost of detecting a clinically significant abnormality was R22 744 (R45 488 + 2 abnormalities).
The following criteria could improve cost-effectiveness of pathological examination of adenotonsillectomy specimens: positive tuberculosis contact at home, systemic symptoms of fever and weight loss, cervical lymphadenopathy >3 cm, suspicious nasopharyngeal appearance, HIV-positive patient, rapid tonsillar enlargement or significant tonsillar asymmetry. On our evidence, routine pathological investigation for South African children does not seem to be justified.
确定行扁桃体切除术和/或腺样体切除术儿童的扁桃体和/或腺样体异常病理发现的发生率，以及扁桃体和腺样体结核的发生率；提出识别有患扁桃体腺样体结核风险的儿童的标准；调查 HIV 与扁桃体腺样体异常的相关性，扁桃体腺样体切除术标本常规病理检查的成本效益，以及决定送哪些标本进行组织学检查的标准。
我们对红新月儿童纪念医院连续行扁桃体切除术或扁桃体腺样体切除术（T&A）的所有儿童（<或=12 岁）进行了为期 8 个月的前瞻性研究。患者术前进行评估，术前和术中对扁桃体大小进行分级。采集血液进行 HIV 检测，所有扁桃体和腺样体均进行组织学检查。进行成本效益分析以确定扁桃体腺样体切除术常规病理检查的成本效益。
共分析了 172 例儿童的 344 个扁桃体（102 例男孩，70 例女孩）；1 例患者患有鼻咽结核，1 例患有扁桃体淋巴瘤；13 例（7.6%）患者的扁桃体不对称性肿大，但无明显异常病理发现。发现临床显著异常的平均成本为 22744 兰特（45488 兰特+2 例异常）。
以下标准可提高扁桃体腺样体切除术标本病理检查的成本效益：家中有结核接触史、发热和体重减轻等全身症状、颈淋巴结肿大>3cm、可疑鼻咽外观、HIV 阳性患者、扁桃体快速肿大或明显不对称。根据我们的证据，南非儿童似乎没有理由进行常规病理检查。
