Wang Ying-Piao, Wang Mao-Che, Lin Hung-Ching, Lee Kuo-Sheng, Chou Pesus
Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, #92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei 104, Taiwan; Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, #155, Sec. 2, Linoon Street, Pei-Tou Dist., Taipei 112, Taiwan; Department of Audiology and Speech Language Pathology and School of Medicine, Mackay Medical College, #46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan.
Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, #155, Sec. 2, Linoon Street, Pei-Tou Dist., Taipei 112, Taiwan; Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, #201, Sec. 2 and School of Medicine, National Yang-Ming University, #155, Sec.2, Linoon Street, Pei-Tou Dist., Taipei 112, Taiwan.
PLoS One. 2015 Apr 7;10(4):e0117535. doi: 10.1371/journal.pone.0117535. eCollection 2015.
Although the tonsils contribute to first line immunity against foreign pathogens in the upper aero-digestive tract, the association of tonsillectomy with the risk of deep neck infection remains unclear. The aim of this study was to assess the incidence rate and risk of deep neck infection among patients who had undergone a tonsillectomy.
This retrospective cohort study evaluated all patients who had undergone tonsillectomy between 2001 and 2009 as identified from the Taiwan National Health Insurance Research Database. For each post-tonsillectomy patient, 10 age-, sex-, and index date-matched controls without a history of tonsillectomy were randomly selected. Cox Proportional hazard model and propensity score model were performed to evaluate the association between tonsillectomy and deep neck infection after adjusting for demographic and clinical data.
There were 34 (71.6 cases per 100,000 person-years) and 174 (36.6 cases per 100,000 person-years) patients that developed deep neck infection in the tonsillectomized and comparison cohorts, respectively. After adjusting for covariates, patients who had undergone a tonsillectomy had a 1.71-fold greater risk of deep neck infection by both Cox proportional hazard model (95% confidence interval, 1.13-2.59) and propensity score model (95% confidence interval, 1.10-2.66). This association was not altered regardless of the indication for tonsillectomy (i.e. chronic/recurrent tonsillitis or sleep apnea/hypertrophy of tonsil) (p = 0.9797).
Based on our review of a nationwide cohort study we identified that the risk of deep neck infection is significantly increased among patients who have undergone a tonsillectomy. Additional research is needed to explore the possible mechanisms behind these findings.
尽管扁桃体有助于对上呼吸道和消化道中的外来病原体产生一线免疫，但扁桃体切除术与深部颈部感染风险之间的关联仍不明确。本研究的目的是评估接受扁桃体切除术的患者中深部颈部感染的发生率和风险。
这项回顾性队列研究评估了从台湾国民健康保险研究数据库中识别出的2001年至2009年间接受扁桃体切除术的所有患者。对于每例扁桃体切除术后的患者，随机选择10名年龄、性别和索引日期匹配且无扁桃体切除术史的对照。在调整人口统计学和临床数据后，采用Cox比例风险模型和倾向评分模型评估扁桃体切除术与深部颈部感染之间的关联。
扁桃体切除组和对照组中分别有34例（每10万人年71.6例）和174例（每10万人年36.6例）患者发生深部颈部感染。在调整协变量后，通过Cox比例风险模型（95%置信区间，1.13 - 2.59）和倾向评分模型（95%置信区间，1.10 - 2.66），接受扁桃体切除术的患者发生深部颈部感染的风险高出1.71倍。无论扁桃体切除术的指征（即慢性/复发性扁桃体炎或睡眠呼吸暂停/扁桃体肥大）如何，这种关联均未改变（p = 0.9797）。
基于我们对一项全国性队列研究的回顾，我们发现接受扁桃体切除术的患者深部颈部感染风险显著增加。需要进一步研究以探索这些发现背后的可能机制。
