Mo Binyu, Dai Shanjun, Yang Li, Li Jihui, Zhu Hanping, Tian Fangyun, Xiao Yi, Huang Xunjian, Zhou Shiping, Wang Qianyi
Department of Otolaryngology，Liuzhou People's Hospital，Liuzhou，545006，China.
Department of Pathology，Liuzhou People's Hospital.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 Sep;38(9):843-848. doi: 10.13201/j.issn.2096-7993.2024.09.013.
To investigate the long-term effect of partial tonsillectomy in children with tonsil hypertrophy. A total of 146 children with obstructive sleep apnea（OSA） who received surgical treatment for tonsil hyperplasia from January 2010 to January 2013 were selected and divided into the observation group（=69） and the control group（=77）. The observation group was received tonsillotomy（TT）, and the control group was received total tonsillectomy（TE）. Parental satisfaction and OSA quality of life questionnaire for children（OSA-18） were surveyed. Residual tonsil size was measured, and polysomnography（PSG） was monitored after 10 years. HE and immunohistochemical analysis were performed on tonsil tissues of one patient who performed a second operation after TT in 2017 year. The results of questionnaire survey showed that the symptoms of respiratory obstruction were significantly improved in both groups, and the satisfaction of TT group was higher than that in the TE group. No increase in the number of respiratory tract infections was observed in all patients. In the TT group, nine cases（13.04%） had tonsil hyperplasia toⅡ°, and the remaining patients had tonsil hyperplasia to Ⅰ°. In addition, one case hadtonsil suppurative infection at the 14th month after surgery, and no recurrence or reoperation was found after treatment. There were seven cases in the TT group and eight cases in the TE group with occasional snoring and mouth breathing after surgery, but the PSG examination of the patients did not meet the diagnosis of OSA. The main causes were obesity and allergic rhinitis. Compared with the first operation, the cicatricial obstruction and infection of tonsil tissue in the second operation were not significantly changed, and the immunohistochemical results also demonstrated that the expression of CD20 was not changed, and the expression of CD3 was decreased. Both TT and TE can effectively improve the symptoms of OSA obstruction in children. TT has less trauma, less postoperative pain, faster recovery and lower rate of hyperplasia, which can be used as one of the main methods for the treatment of tonsil hypertrophy in children.
探讨扁桃体部分切除术对儿童扁桃体肥大的长期影响。选取2010年1月至2013年1月期间因扁桃体增生接受手术治疗的146例阻塞性睡眠呼吸暂停（OSA）患儿，分为观察组（n = 69）和对照组（n = 77）。观察组接受扁桃体切除术（TT），对照组接受扁桃体全切术（TE）。调查家长满意度及儿童OSA生活质量问卷（OSA - 18）。测量残余扁桃体大小，并在10年后进行多导睡眠图（PSG）监测。对2017年接受TT后二次手术的1例患者的扁桃体组织进行苏木精 - 伊红（HE）和免疫组化分析。问卷调查结果显示，两组呼吸道梗阻症状均明显改善，TT组满意度高于TE组。所有患者均未观察到呼吸道感染次数增加。TT组9例（13.04%）扁桃体增生至Ⅱ度，其余患者扁桃体增生至Ⅰ度。此外，1例患者术后14个月出现扁桃体化脓性感染，治疗后未发现复发或再次手术。TT组7例、TE组8例术后偶有打鼾和张口呼吸，但患者的PSG检查未达到OSA诊断标准。主要原因是肥胖和过敏性鼻炎。与首次手术相比，二次手术时扁桃体组织的瘢痕性梗阻和感染无明显变化，免疫组化结果也显示CD20表达未改变，CD3表达降低。TT和TE均可有效改善儿童OSA梗阻症状。TT创伤小、术后疼痛轻、恢复快、增生率低，可作为儿童扁桃体肥大治疗的主要方法之一。
