Yang S Z, Zhou C Y, Wang Z L, Han B C, Sun W H H, Wan Y, Shen G J, Zhang J, Zhang Jiao
Department of Otorhinolaryngology Head and Neck Surgery, the Fourth Medical Center of the People's Liberation Army General Hospital, Beijing 100142, China ColIege of Otolaryngology Head and Neck Surgery, Chinese People's Liberation Army General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Beijing 100048, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Apr 7;57(4):505-509. doi: 10.3760/cma.j.cn115330-20210412-00196.
To assess the incidence of symptomatic torus tubarius hypertrophy (TTH) in recurred OSA in children, and to explore the preliminary experience of partial resection of TTH assisted with radiofrequency ablation. From January 2004 to February 2020, 4 922 children, who diagnosed as OSA and received adenotonsillectomy at the Department of Otolaryngology, The 4th Medical Center of the PLA General Hospital, were retrospectively reviewed. There were 3 266 males and 1 656 females, the age ranged from 1 to 14 years old(median age of 5.0 years). Twenty-two cases were identified with recurrence of OSA syndrome, and the clinical data, including sex, age of primary operation, age of recurrence and presentation, and opertation methods were analyzed. Follow-up was carried out by outpatient visit or telephone. Graphpad prism 5.0 software was used for statistical analysis. Twenty-two cases were identified as recurred OSA and received revised surgery in 4 922 cases. Among these 22 cases, 11 cases were diagnosed as TTH resulting in an incidence of 2.23‰(11/4 922), 1 case was cicatricial adhesion on tubal torus (0.20‰, 1/4 922), 10 cases were residual adenoid combined with tubal tonsil hypertrophy (2.03‰, 10/4 922). Median age of primary operation was 3.0 years (range:2.4 to 6.0 years) in 11 TTH cases. Recurrent interval varied from 2 months to 5.5 years (2.4±1.9 years) after first operation. Age of revised partial resection of TTH was 7.0±2.7 years (range: 4.0 to 12.0 years). Average time interval between primary operation and revised operation was 3.5±2.1 years (range: 0.5 to 6.0 years). Individualized treatments were carried out based on partial resection of TTH assisted with radiofrequency ablation. All of 11 cases received satisfied therapeutic results without nasopharyngeal stenosis occured. Twenty-two cases were followed up for 1.6 to 13 years (median follow-up time was 6.2 years). TTH contributed to recurred OSA in child. TTH might be misdiagnosed as tubal tonsil hypertrophy. Partial resection of TTH assisted with radiofrequency ablation was a safty and effective treatment.
评估儿童复发性阻塞性睡眠呼吸暂停（OSA）中症状性咽鼓管圆枕肥大（TTH）的发生率，并探讨TTH部分切除术联合射频消融的初步经验。回顾性分析2004年1月至2020年2月在解放军总医院第四医学中心耳鼻咽喉科诊断为OSA并接受腺样体扁桃体切除术的4922例儿童。其中男性3266例，女性1656例，年龄1至14岁（中位年龄5.0岁）。22例被确诊为OSA综合征复发，分析其临床资料，包括性别、初次手术年龄、复发年龄及表现、手术方式等。通过门诊或电话进行随访。采用Graphpad prism 5.0软件进行统计分析。4922例中22例被确诊为复发性OSA并接受再次手术。这22例中，11例诊断为TTH，发生率为2.23‰（11/4922），1例为咽鼓管圆枕瘢痕粘连（0.20‰，1/4922），10例为残留腺样体合并咽鼓管扁桃体肥大（2.03‰，10/4922）。11例TTH病例初次手术的中位年龄为3.0岁（范围：2.4至6.0岁）。首次手术后复发间隔为2个月至5.5年（2.4±1.9年）。TTH部分切除术的年龄为7.0±2.7岁（范围：4.0至12.0岁）。初次手术与再次手术的平均时间间隔为3.5±2.1年（范围：0.5至6.0年）。基于TTH部分切除术联合射频消融进行个体化治疗。11例均获得满意治疗效果，无鼻咽狭窄发生。22例随访1.6至13年（中位随访时间为6.2年）。TTH是儿童复发性OSA的原因之一。TTH可能被误诊为咽鼓管扁桃体肥大。TTH部分切除术联合射频消融是一种安全有效的治疗方法。
