Guo Weijuan, Lei Qiming
Department of Otolaryngology Head and Neck Surgery，Tianshui Combine Traditional Chinese and Western Medicine Hospital，Tianshui，741020，China.
The First Clinical Medical College，Lanzhou University.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 Dec;38(12):1161-1165;1169. doi: 10.13201/j.issn.2096-7993.2024.12.013.
To analyze the effects of adenoidectomy, tonsillectomy and tonsillectomy combined with adenoidectomy on obstructive sleep apnea children by computational fluid dynamics numerical simulation. A case of typical tonsil with adenoid hypertrophy was selected. Mimics 21.0 software was used to establish the original preoperative model, adenoidectomy, tonsillectomy and virtual surgical models of tonsillectomy combined adenoidectomy, and the computational fluid dynamics model of the upper airway was established by ANSYS 2019 R1 software, and then the pressure and velocity of the internal flow field of the CFD model were numerically simulated. Seven planes perpendicular to the flow trace were selected as the observation planes, including the cross section of the sinusostoma complex, the anterior end of the adenoid body, the narrowest cross section of the nasopharyngeal cavity, the pharyngostoma tube, the narrowest cross section of the oropharyngeal cavity, the lower pole of the tonsil and the glottis section. The comparison indexes included pressure, flow velocity and flow distribution. Compared with the original model before operation, after the adenoids were removed only, the pressure drop between the section of the ostiomeatal complex and the section of the eustachian tube decreased, the high velocity peak at the anterior end of the adenoids disappeared, and the flow trace through the middle nasal canal increased. When only bilateral tonsils were removed, the pressure drop between the eustachian tube and the glottis slowed down and the flow velocity between the eustachian tube and the glottis slowed down. Combined tonsillar-adenoidectomy resulted in the most uniform pressure distribution, the most gentle pressure change and flow rate in the upper airway, and the most ignificant increase in airflow trace through the middle nasal canal among the three operations. Adenoidectomy, tonsillectomy and combined tonsillar adenoidectomy can make the airflow velocity and pressure of upper respiratory tract uniform to different degrees, but there are obvious differences in the specific anatomical location and degree. The application of CFD can intuitively predict the improvement of upper airway flow field in OSA children by different surgical methods, which helps clinicians to make surgical decision.
通过计算流体动力学数值模拟分析腺样体切除术、扁桃体切除术以及扁桃体切除术联合腺样体切除术对阻塞性睡眠呼吸暂停儿童的影响。选取1例典型的扁桃体伴腺样体肥大病例。使用Mimics 21.0软件建立术前原始模型、腺样体切除术、扁桃体切除术以及扁桃体切除术联合腺样体切除术的虚拟手术模型，并通过ANSYS 2019 R1软件建立上气道的计算流体动力学模型，然后对CFD模型内部流场的压力和速度进行数值模拟。选取7个垂直于气流轨迹的平面作为观察平面，包括鼻窦口复合体截面、腺样体前端、鼻咽腔最窄截面、咽口管、口咽腔最窄截面、扁桃体下极和声门截面。比较指标包括压力、流速和流量分布。与术前原始模型相比，单纯切除腺样体后，鼻窦口复合体截面与咽鼓管截面之间的压降减小，腺样体前端的高速峰值消失，通过中鼻道的气流轨迹增加。单纯切除双侧扁桃体时，咽鼓管与声门之间的压降减缓，咽鼓管与声门之间的流速减缓。在三种手术中，扁桃体切除术联合腺样体切除术导致上气道压力分布最均匀，压力变化和流速最平缓，通过中鼻道的气流轨迹增加最为显著。腺样体切除术、扁桃体切除术以及扁桃体切除术联合腺样体切除术均可使上呼吸道的气流速度和压力在不同程度上趋于均匀，但在具体解剖位置和程度上存在明显差异。CFD的应用可以直观地预测不同手术方法对OSA儿童上气道流场的改善情况，有助于临床医生做出手术决策。
