Lin Dai-Lou, Wu Chuan-Song, Tang Chao-Hsiun, Kuo Ting-Yu, Tu Tzong-Yang
Department of Otolaryngology Head & Neck Surgery, Fu Jen Catholic University Hospital, Taipei, Taiwan; Department of Otolaryngology Head & Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Otolaryngology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan.
Auris Nasus Larynx. 2018 Dec;45(6):1191-1198. doi: 10.1016/j.anl.2018.03.002. Epub 2018 Mar 30.
To investigate the safety of adenoidectomy and risk factors of re-adenoidectomy, and intend to provide evidence-based information to clinicians for further consideration.
This study was based on data obtained from Taiwan's National Health Insurance Research Database from the period 2002-2011. We utilized that data from the hospitalization group and collected information regarding those individuals who accepted adenoidectomy with or without tonsillectomy and post-adenoidectomy bleeding. Thereafter, we performed univariate and multi-variate analysis to explore the possible risk factors of re-adenoidectomy.
A total of 5435 individuals who accepted a first adenoidectomy with or without tonsillectomy were collected. After further tracing treatment of these individuals, 107 (1.97%) accepted the revision adenoidectomy until 2011. Post-op bleeding was approximately 0.28%. The revision rate associated with patient age showed the following: 0-4 years (0.61%), 4-12 years (2.06%) and 12-18 years (2.56%). The revision rate associated with surgeon age showed: 28-41 years (1.42%), 41-50 years (2.96%), 50-65 years (2.74%); the surgeons' surgery volume showed low (4.34%), medium (0.71%), and higher (1.02%). There are 4 diseases (otitis media with effusion, sinusitis, chronic pharyngitis, and sleep disorder) that showed a significant relationship with the revision rate when subject to univariate and multivariate analysis. The revision rate incorporating hospital locations, volumes and levels revealed no significant difference with each other.
Adenoidectomy is a generally safe surgical procedure, with low complication and low revision rate. Our study indicated that the revision rate of adenoidectomy might be lower when performed by young visiting staff with medium to higher surgical volume in the medium to higher volume hospital. If patients had diseases such as otitis media with effusion, sinusitis, chronic pharyngitis, and sleep disorder, they would be subject to higher rate of re-adenoidectomy. Surgeons should be aware and sufficiently explain this information to the parents before surgery.
探讨腺样体切除术的安全性及再次腺样体切除术的危险因素，旨在为临床医生提供循证信息以供进一步参考。
本研究基于2002 - 2011年台湾地区国民健康保险研究数据库所获数据。我们利用住院组数据，收集了接受腺样体切除术（伴或不伴扁桃体切除术）及腺样体切除术后出血患者的相关信息。此后，我们进行单因素和多因素分析以探究再次腺样体切除术的可能危险因素。
共收集了5435例接受首次腺样体切除术（伴或不伴扁桃体切除术）的患者。对这些患者进行进一步随访治疗后，截至2011年，有107例（1.97%）接受了再次腺样体切除术。术后出血率约为0.28%。与患者年龄相关的再次手术率如下：0 - 4岁（0.61%），4 - 12岁（2.06%），12 - 18岁（2.56%）。与外科医生年龄相关的再次手术率如下：28 - 41岁（1.42%），41 - 50岁（2.96%），50 - 65岁（2.74%）；外科医生的手术量显示低手术量者（4.34%），中等手术量者（0.71%），高手术量者（1.02%）。在进行单因素和多因素分析时，有4种疾病（分泌性中耳炎、鼻窦炎、慢性咽炎和睡眠障碍）与再次手术率显示出显著相关性。纳入医院位置、数量和级别后的再次手术率相互之间无显著差异。
腺样体切除术是一种总体安全的外科手术，并发症少且再次手术率低。我们的研究表明，在中高手术量医院，由年轻的客座医护人员进行腺样体切除术，且手术量为中高时，再次手术率可能较低。如果患者患有分泌性中耳炎、鼻窦炎、慢性咽炎和睡眠障碍等疾病，他们再次腺样体切除术的发生率会更高。外科医生在手术前应意识到这一点，并向家长充分解释这些信息。
