Wittlinger Jan, Stankovic Petar, Girrbach Ulrike, Gradistanac Tanja, Güldner Christian, Teymoortash Afshin, Hoch Stephan, Günzel Thomas, Wilhelm Thomas
Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Rudolf-Virchow-Strasse 2, 04552, Borna, Germany.
Institute of Pathology, University Leipzig, Leipzig, Germany.
Eur Arch Otorhinolaryngol. 2017 Jul;274(7):2927-2932. doi: 10.1007/s00405-017-4575-y. Epub 2017 Apr 24.
Postoperative haemorrhage following tonsillectomy occurs in 5.98% of all cases with up to 10 deaths reported annually in Germany. When comparing tonsillectomy (TE) and tonsillotomy (TT), the same long-term frequency of ENT infections is displayed in children and young adults. However, taking postoperative haemorrhaging into account, TT is more favourable. Chronic tonsillitis is one of the most common indications for TE in the adult population; however, a histopathological characterization may reveal objective criteria and provide a foundation for routinely performing TT in adults too. Three essential parameters hyperplasia (HP), grade of inflammation (GOI) and activity of inflammation (AOI), which are responsible for, and associated with a clinically relevant disease were histopathologically examined in the tonsils of 100 adult patients with chronic recurrent tonsillitis. The parameters were analysed and compared separately in the pharyngeal and basal parts of the tonsils as well as in three sections (upper and lower pole of the tonsil, middle part) as this may influence the indication for TT. The comparison of the basal and pharyngeal portions displayed a significant difference in the GOI and the HP in all three sections: grade 2 HP as well as GOI were more commonly found in the basal than pharyngeal portions (p > 0.001). AOI (grade 2) displayed the same properties in the middle section (p < 0.002), but did not reach statistical significance in the cranial and caudal sections (p = 0.107 and p = 0.186). An overabundance of grade 1 GOI, AOI, and HP was seen in the pharyngeal sections. The results show that two out of three relevant parameters that demonstrate histopathological changes in recurrent inflamed tonsils have a significantly stronger presence in the basal section of the tonsil as opposed to the pharyngeal section. The processes initiated by inflammation next to the surface responsible for a clinically relevant recurrent tonsillitis seem to cause stronger reactions in the deep follicular portion of the tonsils.
扁桃体切除术后出血在所有病例中的发生率为5.98%，在德国每年有多达10例死亡报告。在儿童和年轻人中，比较扁桃体切除术（TE）和扁桃体切开术（TT）时，耳鼻喉感染的长期发生率相同。然而，考虑到术后出血情况，TT更具优势。慢性扁桃体炎是成人进行TE最常见的指征之一；然而，组织病理学特征可能揭示客观标准，并为成人常规施行TT提供依据。对100例患有慢性复发性扁桃体炎的成年患者的扁桃体进行组织病理学检查，研究了三个与临床相关疾病相关且起作用的基本参数：增生（HP）、炎症分级（GOI）和炎症活性（AOI）。由于这可能影响TT的指征，因此分别在扁桃体的咽部和基部以及三个部分（扁桃体的上极和下极、中部）对这些参数进行了分析和比较。基部和咽部的比较显示，在所有三个部分中，GOI和HP均存在显著差异：2级HP以及GOI在基部比咽部更常见（p>0.001）。AOI（2级）在中部表现出相同的特性（p<0.002），但在头部和尾部未达到统计学意义（p=0.107和p=0.186）。咽部切片中可见1级GOI、AOI和HP过多。结果表明，在复发性发炎扁桃体中显示组织病理学变化的三个相关参数中有两个在扁桃体基部比咽部明显更强。扁桃体表面附近由炎症引发的导致临床相关复发性扁桃体炎的过程似乎在扁桃体深部滤泡部分引起更强反应。
