Long Songliang,Zhang Xiaping.Efficacies of nasal endoscopic cryogenic plasma adenoidectomy for pediatric adenoid hypertrophy[J].Journal of Clinical Pediatric Surgery,2024,(06):578-583.[doi:10.3760/cma.j.cn101785-202401048-013]
鼻内镜下低温等离子腺样体消融术治疗小儿腺样体肥大疗效观察
- Title:
- Efficacies of nasal endoscopic cryogenic plasma adenoidectomy for pediatric adenoid hypertrophy
- Keywords:
- Adenoidectom; Ablation Techniques; Treatment Outcome; Comparative Study; Child
- 摘要:
- 目的 探讨鼻内镜下低温等离子腺样体消融术治疗小儿腺样体肥大的临床效果。 方法 回顾性分析2020年2月至2023年2月湖南省儿童医院耳鼻咽喉头颈外科收治的100例(按样本计算公式得出最少样本量为96例)腺样体肥大患儿临床资料,依据所采取手术方法的不同分为鼻内镜下低温等离子腺样体消融术组(简称低温等离子消融术组)和鼻内镜下腺样体切除术组(简称常规切除术组),每组各50例。收集并对比分析两组患儿手术相关指标、疼痛程度、创伤应激指标、CC类趋化因子中CCL2和CCL21、通气功能指标、生活质量、术后并发症及复发情况。 结果 低温等离子消融术组患儿术中出血量及手术时间少于常规切除术组(P＜0.05),咽痛持续时间、恢复鼻腔通气时间以及白膜完全消退时间均短于常规切除术组(P＜0.05);手术后第1、2、3 天,患儿疼痛视觉模拟评分法(visual analogue scale for pain,VAS)评分以及前列腺素F2α(prostaglandin F2α,PG F2α)、前列腺素E2(prostaglandin E2,PGE2)、皮质醇(cortisol hydrocortisone,Cor)、降钙素原(procalcitonin,PCT)、CCL21水平、血氧饱和度<90%时间占睡眠时间百分比(percentage of time with oxygen saturation <90% during sleep,SLT 90%)、血氧饱和度下降指数(oxygen desatura tion indes,ODI)、最长呼吸暂停时间(longest apnea time,LAT)、呼吸暂停通气指数(apnea and hypopnea index,AHI),均低于常规切除术组(P＜0.05);CCL2水平、最低夜间血氧饱和度(lowest oxygen saturation,LSaO2)以及生活质量评分均高于常规切除术组(P＜0.05)。低温等离子消融术组患儿治疗总有效率为92.00%(46/50),高于常规切除术组(38/50,76.00%),差异有统计学意义(χ2=4.762,P＜0.05);术后并发症发生率(2/50,4.00%)低于常规切除术组(9/50,18.00%),差异有统计学意义(χ2=5.005,P＜0.05),而复发率[(1/50,2.00%)比(2/50,4.00%)]差异无统计学意义(χ2=0.000,P>0.05)。 结论 鼻内镜下低温等离子腺样体消融术治疗小儿腺样体肥大,与鼻内镜下腺样体切除术相比,手术时间更短,术中出血量更少,并发症更少,复发率无差异,可有效改善患儿通气功能。
- Abstract:
- Objective To explore the efficacy of nasal endoscopic hypothermia plasma adenoid resection for pediatric adenoid hypertrophy.Methods From February 2020 to February 2023,100 children with adenoid hypertrophy were recruited retrospectively.According to surgical approaches,they were assigned into two groups of nasal endoscopic cryogenic plasma adenoidectomy (cryogenic plasma) and nasal endoscopic adenoidectomy (conventional resection)(n=50 each).Operation-related parameters,pain score,traumatic stress parameters,CCL2/21,nasal volume,ventilatory function parameters,quality-of-life,clinical efficacy,postoperative complications and recurrence were recorded.Results Volume of intraoperative hemorrhage was less in cold plasma group than that in conventional resection group (P＜0.05) and operative duration shorter than conventional resection group (P＜0.05).Duration of pharyngeal pain,nasal recovery ventilation and complete regression of tunica albuginea were shorter than conventional resection group (P＜0.05).At Day 1/2/3,VAS scores of cryogenic plasma group were lower than those of conventional resection group (P＜0.05).PGF2 α,PGE 2,Cor,PCT,CCL21,SLT,90%,ODI,LAT and AHI were lower than conventional resection group (P＜0.05) while CCL2,nasal volume,LSaO2 and quality-of-life score were higher than conventional resection group (P＜0.05).Overall response rate of cryogenic plasma group was higher than that of conventional resection group (χ2=4.762,P＜0.05).Postoperative complication rate was lower in cold plasma group than that in conventional resection group [(4.00%(2/50) vs.18.00%(9/50)](χ2=5.005,P＜0.05).However,inter-group recurrence rate was insignificant [2.00%(1/50) vs.4.00%(2/50)](χ2=0.000,P＞0.05).Conclusions For adenoid hypertrophy in children,nasal endoscopic inferior plasma adenoid ectomy may shorten operative duration,minimize volume of intraoperative hemorrhage and effectively improve ventilation function as compared with conventional resection.
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备注/Memo
收稿日期:2024-01-19。
通信作者:张霞平,Email:233407658@qq.com