Mangiardi Jason, Graw-Panzer Katharina D, Weedon Jeremy, Regis Theresa, Lee Haesoon, Goldstein Nira A
Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA.
Int J Pediatr Otorhinolaryngol. 2010 Dec;74(12):1361-6. doi: 10.1016/j.ijporl.2010.09.003. Epub 2010 Sep 28.
To demonstrate similar improvement in pediatric sleep-disordered breathing (SDB) as determined by polysomnography (PSG) with microdebrider-assisted partial intracapsular tonsillectomy and adenoidectomy (PITA) versus Bovie electrocautery complete tonsillectomy and adenoidectomy (T&A).
In this retrospective cohort study, 30 children found to have SDB by PSG who have undergone either PITA (15 participants) or T&A (15 participants) as treatment were evaluated with standardized history and physical examination and unattended home overnight PSG.
Median change in apnea-hypopnea index (AHI) was 1.7 (-4.9 to 29.8) for the PITA group and 2.3 (-10.9 to 64.1) for the T&A group, although there was substantially more variability in the T&A group. A mixed linear model evaluating the relation of surgical group with change in AHI demonstrated no significant differences in group means (F[1,13]=0.31, P=.590) but the variances differed significantly (residual likelihood ratio chi-square=5.24, df=1, P=.022). Five of 15 (33%) PITA patients and 4 of 15 (27%) T&A patients had postoperative AHI scores of ≤5; this difference was not statistically significant (Fisher exact test P=1.000). There was no significant interaction or substantial confounding effect of age, sex, race, preoperative tonsil size, preoperative AHI, or body mass index in the model relating surgery type to reduction of postoperative AHI to ≤5.
Our study demonstrates no clinically or statistically significant differences in PSG and clinical outcomes between PITA and T&A for treatment of pediatric SDB in otherwise healthy children.
通过多导睡眠图（PSG）来证明，对于小儿睡眠呼吸障碍（SDB），微切割器辅助部分囊内扁桃体切除术和腺样体切除术（PITA）与博维电灼全扁桃体切除术和腺样体切除术（T&A）相比，二者疗效改善情况相似。
在这项回顾性队列研究中，对30名经PSG检查发现患有SDB且已接受PITA（15名参与者）或T&A（15名参与者）治疗的儿童进行了标准化病史和体格检查以及无人值守的家庭夜间PSG评估。
PITA组的呼吸暂停低通气指数（AHI）中位数变化为1.7（-4.9至29.8），T&A组为2.3（-10.9至64.1），尽管T&A组存在更大的变异性。评估手术组与AHI变化关系的混合线性模型显示，两组均值无显著差异（F[1,13]=0.31，P=0.590），但方差有显著差异（残差似然比卡方=5.24，自由度=1，P=0.022）。15名PITA患者中有5名（33%）术后AHI评分≤5，15名T&A患者中有4名（27%）术后AHI评分≤5；这一差异无统计学意义（Fisher精确检验P=1.000）。在手术类型与术后AHI降低至≤5的关系模型中，年龄、性别、种族、术前扁桃体大小、术前AHI或体重指数均无显著交互作用或实质性混杂效应。
我们的研究表明，对于健康儿童的小儿SDB治疗，PITA和T&A在PSG及临床结果方面无临床或统计学显著差异。
