Das Amal T, Prakash S B, Priyadarshini V
Assistant Professor, Department of ENT and HNS, DM Wayanad Institute of Medical Sciences , Wayanad, Kerala, India .
Associate Professor, Department of ENT and HNS, DM Wayanad Institute of Medical Sciences , Wayanad, Kerala, India .
J Clin Diagn Res. 2017 Feb;11(2):MC05-MC07. doi: 10.7860/JCDR/2017/24682.9394. Epub 2017 Feb 1.
Adenoidectomy is one of the most commonly performed surgical procedures in children. Conventional adenoidectomy is associated with incomplete adenoid tissue removal with persistence of symptoms. The advent of rigid nasal endoscopes, cold light source, fiber optics and powered instruments used in functional endoscopic sinus surgery helped in the development of endoscopic microdebrider-assisted adenoidectomy.
To establish the safety and efficacy of combined conventional and endoscopic microdebrider-assisted adenoidectomy procedure.
This is a prospective study of 60 child patients who underwent combined conventional and endoscopic microdebrider-assisted adenoidectomy. The study was conducted from September 2013 to September 2015. Only child patients with grade 3 and grade 4 Adenoid Hypertrophy (AH) was included in the study. At the end of conventional adenoidectomy and after combined procedure, the AH was graded again. Post-operative complications like neck pain, hypernasality and swallowing problems were noted. Their symptom score was reviewed before surgery and after one month and one year of surgery. The duration of surgery and amount of blood loss was recorded.
By this technique, complete clearance of adenoid tissue was obtained in all 60 (100%) cases. The mean pre-operative symptom score for AH was 3.7, which improved to 0 after one month of combined conventional and endoscopic microdebrider-assisted adenoidectomy. All child patients were symptom-free at the end of one month and one year. The duration of conventional adenoidectomy was 5 minutes 12 seconds while total duration of the combined conventional and endoscopic microdebrider-assisted adenoidectomy was 14 minutes 45 seconds. There was no significant blood loss (15±3 ml approximately). There were no major complications in this study.
The combined approach of conventional curette along with endoscopic microdebrider-assisted adenoidectomy is a safe and effective method for complete and accurate removal of large adenoids.
腺样体切除术是儿童最常施行的外科手术之一。传统腺样体切除术与腺样体组织切除不完全及症状持续存在有关。功能性鼻内镜鼻窦手术中使用的硬性鼻内镜、冷光源、纤维光学和动力器械的出现，推动了内镜下微切割吸引器辅助腺样体切除术的发展。
确定传统与内镜下微切割吸引器辅助腺样体切除术联合应用的安全性和有效性。
这是一项对60例接受传统与内镜下微切割吸引器辅助腺样体切除术联合手术的儿童患者的前瞻性研究。研究于2013年9月至2015年9月进行。仅纳入3级和4级腺样体肥大（AH）的儿童患者。在传统腺样体切除术后及联合手术后，再次对腺样体肥大进行分级。记录术后并发症，如颈部疼痛、鼻音过重和吞咽问题。在手术前以及术后1个月和1年对其症状评分进行复查。记录手术时间和失血量。
通过该技术，所有60例（100%）患者的腺样体组织均被完全清除。腺样体肥大术前平均症状评分为3.7，在传统与内镜下微切割吸引器辅助腺样体切除术联合手术后1个月降至0。所有儿童患者在1个月和1年时均无症状。传统腺样体切除术的时间为5分12秒，而传统与内镜下微切割吸引器辅助腺样体切除术联合手术的总时间为14分45秒。失血量无显著差异（约15±3 ml）。本研究中无重大并发症。
传统刮匙与内镜下微切割吸引器辅助腺样体切除术联合应用是一种安全有效的方法，可完整、准确地切除大型腺样体。
