Noda Masao, Koshu Ryota, Dias Mari, Saito Chizu, Ito Makoto
Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN.
Cureus. 2024 Jun 3;16(6):e61621. doi: 10.7759/cureus.61621. eCollection 2024 Jun.
Pediatric obstructive sleep apnea (OSA) caused by adenoids or an enlarged palatine tonsil has a negative impact on physical and mental growth. Surgical removal of the tissue is effective but entails a life-threatening risk of postoperative bleeding, which is up to 30 times higher in chronic pediatric disease cases. However, endoscopes and resection devices provide safe, reliable surgical methods. Here, we report the efficacy and safety of endoscopic powered intracapsular tonsillectomy and adenoidectomy (PITA) for pediatric OSA in patients with high-risk comorbidities.
This retrospective case series included pediatric patients with OSA who underwent PITA at a single tertiary medical center between April 2017 and May 2023. Ten patients (three males and seven females; mean age 6.4 years, range 2-12 years) were included; all met the Japanese criteria for complex chronic pediatric conditions.
The average operative time was 61 min; a microdebrider was used in eight cases and a coblator in two cases. Although there was no postoperative bleeding, one case experienced regrowth.
Our data show that an endoscopic PITA approach could reduce the risk of severe bleeding and relieve the sleeping conditions of pediatric patients with complex chronic OSA.
腺样体或腭扁桃体肿大引起的小儿阻塞性睡眠呼吸暂停（OSA）对身心发育有负面影响。手术切除该组织有效，但术后出血存在危及生命的风险，在慢性儿科疾病病例中，这种风险高达30倍。然而，内窥镜和切除设备提供了安全可靠的手术方法。在此，我们报告了内窥镜动力囊内扁桃体切除术和腺样体切除术（PITA）对患有高危合并症的小儿OSA患者的疗效和安全性。
本回顾性病例系列纳入了2017年4月至2023年5月在单一三级医疗中心接受PITA治疗的小儿OSA患者。纳入10例患者（3例男性，7例女性；平均年龄6.4岁，范围2 - 12岁）；所有患者均符合日本复杂慢性儿科疾病标准。
平均手术时间为61分钟；8例使用了微型切割器，2例使用了等离子刀。虽然没有术后出血，但有1例出现了组织再生。
我们的数据表明，内窥镜PITA方法可以降低严重出血的风险，并改善患有复杂慢性OSA的小儿患者的睡眠状况。
