Naik Paresh P, Lakshanadeve V M, Kurien Mary, Thomas Kurien
University Hospital of Northamptonshire, Northampton, UK.
Department of ENT, Pondicherry Institute of Medical Sciences, Pondicherry, India.
Indian J Otolaryngol Head Neck Surg. 2023 Dec;75(4):3481-3486. doi: 10.1007/s12070-023-03992-y. Epub 2023 Jun 30.
Endoscopic adenoidectomy with powered instruments,a challenge in resource-constraint developing countries, has been on the rise. To evaluate conventional curettage as compared to endoscopic assisted adenoidectomy in the successful management of adenoid enlargement. A randomized controlled double-blinded study among children undergoing adenoidectomywas done. Primary outcomes were assessed by pre- and postoperative evaluation with a symptoms questionnaire and fiberoptic nasal endoscopy. There were 71 children aged 3-15 years, majority having grade III adenoids. Conventional adenoidectomy was done by the surgeon who was blinded to preoperative adenoid status. Patients were randomized to two groups, 35in conventional curettage where no further on-table intervention was done. Check endoscopyof the remaining 36 patients, formingthe second group, revealed residual grade III adenoidsin 5.6%. They underwentcompletion adenoidectomyendoscopically. By the 12th postoperative week, nasal endoscopy noted that 39.3% had grade I/II and 8.8% had grade I in the conventional and endoscopic groups respectively. Thoughstatistically significant, all pre-op symptoms settled except sleep-related ones which persisted in both groups (25% versus 14.7) with no complications in either group. Relief of all symptoms other than sleep-related ones, was achieved despite residual adenoids being up to grade II in both conventional and endoscopic group. This suggests non-obstructive causes in a subset of these patients. Conventional adenoid curettage is comparable to endoscopic adenoidectomy by cold method among children aged three and above. Complete adenoidclearance for achieving 'anatomical success' appears not to be necessary for 'clinical success'.
使用电动器械进行内镜下腺样体切除术在资源有限的发展中国家是一项挑战，但其应用呈上升趋势。为评估传统刮除术与内镜辅助腺样体切除术在成功治疗腺样体肥大方面的效果，对接受腺样体切除术的儿童进行了一项随机对照双盲研究。主要结局通过术前和术后症状问卷及纤维鼻内镜评估。共有71名3至15岁儿童，大多数为Ⅲ度腺样体肥大。由对术前腺样体状态不知情的外科医生进行传统腺样体切除术。患者被随机分为两组，35例接受传统刮除术，术中未进行进一步干预。其余36例患者组成第二组，检查性内镜检查发现5.6%有残留Ⅲ度腺样体，他们接受了内镜下腺样体切除完成术。术后第12周，鼻内镜检查发现传统组和内镜组分别有39.3%为Ⅰ/Ⅱ度、8.8%为Ⅰ度。尽管有统计学意义，但除睡眠相关症状外，所有术前症状均得到缓解，两组睡眠相关症状均持续存在（25%对14.7%），且两组均无并发症。尽管传统组和内镜组均有高达Ⅱ度的残留腺样体，但除睡眠相关症状外的所有症状均得到缓解。这表明这些患者中有一部分存在非梗阻性病因。对于3岁及以上儿童，传统腺样体刮除术与冷法内镜下腺样体切除术效果相当。实现“临床成功”似乎并不一定需要完全清除腺样体以达到“解剖学成功”。
