Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, USA; Division of Pediatric Otolaryngology, Texas Children's Hospital, Houston, TX, USA.
Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
Int J Pediatr Otorhinolaryngol. 2022 Jan;152:110978. doi: 10.1016/j.ijporl.2021.110978. Epub 2021 Nov 11.
Outcomes following intracapsular tonsillectomy (IT) have not been well established in children with developmental delays. The objective of this study was to compare outcomes and complications between intracapsular and extracapsular tonsillectomy (TT) in pediatric patients with developmental delay (DD) in comparison to non-developmentally delayed children.
This is a retrospective study of pediatric patients with DD undergoing tonsillectomy between 2016 and 2019 at a tertiary care hospital. This group included patients with Down Syndrome, Autism Spectrum Disorder, other genetic syndromes, and patients with a diagnosis of global developmental delay. Outcomes and complications were analyzed for IT and TT.
2267 charts were reviewed, and 320 patients were identified with DD. Of those, 72 patients underwent IT and 248 underwent TT. In the DD cohort, the IT group had a shorter length of stay (0.97 vs 1.7 days, p < .0001) and was less likely to receive post-operative narcotic medication (2.8% vs 35%, p < .0001) and corticosteroids (9.7% vs 64%, p < .0001) during their hospital stay. Reductions in emergency room (ER) visits (5.6% vs 10%, p = .21) and post-op bleeding (PTH) (1.4% vs 4.8%, p = .31) for IT vs TT were not statistically significant in the DD group. In the NDD group, fewer patients undergoing IT returned to the ER (11% vs 2.3%, p < .0001) or had PTH (4.8% vs 0.25%, p, 0.0001) as compared to those children undergoing TT. There was no difference between parental report of symptom improvement between the groups (39% vs 33%, p = .39). Analysis of 180 patients with preoperative and postoperative sleep study data revealed post-op Apnea Hypopnea Index (AHI) improved with both techniques (74% TT vs 79% IT, p = .7). There were no differences noted for persistent obstructive sleep apnea (OSA) among the two techniques for both study groups (p = .63).
Children with DD undergoing IT have reduced length of stay and reduced inpatient administration of post-operative opioids and steroids. IT has comparable efficacy to TT in treating symptoms of pediatric sleep apnea with a better safety profile. Overall, children undergoing IT return to the operating room less frequently than those undergoing TT. Longer follow-up studies will be needed to evaluate rate of tonsil regrowth, risk of revision surgery and persistence of OSA in these patients.
在发育迟缓的儿童中，囊内扁桃体切除术（IT）的结果尚未得到很好的确定。本研究的目的是比较发育迟缓（DD）和非发育迟缓儿童的儿童行扁桃体囊内切除术（TT）和扁桃体囊外切除术（TT）的结果和并发症。
这是一项对 2016 年至 2019 年在一家三级保健医院接受扁桃体切除术的发育迟缓儿童的回顾性研究。该组包括唐氏综合征、自闭症谱系障碍、其他遗传综合征患者，以及被诊断为全面发育迟缓的患者。分析了 IT 和 TT 的结果和并发症。
共回顾 2267 份病历，发现 320 名 DD 患者。其中，72 例行 IT，248 例行 TT。在 DD 组中，IT 组的住院时间更短（0.97 天 vs 1.7 天，p < 0.0001），术后接受阿片类药物（2.8% vs 35%，p < 0.0001）和皮质类固醇（9.7% vs 64%，p < 0.0001）的可能性更小。与 TT 相比，IT 组的急诊室（ER）就诊率（5.6% vs 10%，p = 0.21）和术后出血（PTH）（1.4% vs 4.8%，p = 0.31）减少没有统计学意义。在 NDD 组中，与 TT 相比，行 IT 的患儿返回 ER（11% vs 2.3%，p < 0.0001）或发生 PTH（4.8% vs 0.25%，p < 0.0001）的患者较少。两组患儿父母报告的症状改善情况无差异（39% vs 33%，p = 0.39）。对 180 名有术前和术后睡眠研究数据的患者进行分析显示，两种手术方法均可改善术后呼吸暂停低通气指数（AHI）（74% TT 与 79% IT，p = 0.7）。两组患者中两种手术方法对持续性阻塞性睡眠呼吸暂停（OSA）的效果无差异（p = 0.63）。
行 IT 的 DD 患儿住院时间缩短，术后阿片类药物和皮质类固醇的使用减少。IT 在治疗儿童睡眠呼吸暂停症状方面与 TT 具有相同的疗效，安全性更好。总体而言，与 TT 相比，行 IT 的患儿返回手术室的频率较低。需要进行更长时间的随访研究，以评估这些患者的扁桃体复发率、再次手术风险和 OSA 持续存在的情况。
