鼻内镜下腺样体等离子切除术联合扁桃体等离子囊内切除术在小儿鼾症中的疗效及安全性分析

Analysis of efficacy and safety of nasal endoscopic adenoidectomy with plasma ablation combined with coblation intracapsular tonsillectomy in pediatric obstructive sleep apnea

摘要

目的 分析鼻内镜下腺样体等离子切除术联合扁桃体等离子囊内切除术（coblation intracapsular tonsillectomy,CIT）治疗小儿鼾症的疗效及安全性。方法 选取2024年7月—2025年9月于安徽医科大学附属滁州医院接受手术治疗的小儿鼾症患儿106例,按手术方式分为对照组（51例,行腺样体等离子切除术联合扁桃体全切术）与观察组（55例,行腺样体等离子切除术联合CIT）。比较2组围术期指标,术后24 h、48 h、72 h疼痛行为量表（face,legs,activity,cry,consolability scale,FLACC）;术前及术后2周呼吸功能：最低血氧饱和度（lowest oxygen saturation,LSaO₂）、夜间经皮血氧饱和度<90%的时间占总监测时间的百分比（the percentage of the totalrecorded time spent below 90% oxygen saturation,T90）、呼吸暂停事件次数、单次最长持续时间、睡眠与生活质量评分[魁北克睡眠问卷（quebec sleep questionnaire,QSQ）、阻塞性睡眠呼吸暂停生活质量状况量表（obstructive sleep apnea 18 items survey,OSA-18）];评价临床疗效及术后并发症发生情况（继发性出血、发热、手术部位感染、鼻咽粘连）。结果 与对照组相比,观察组的手术时间更短,扁桃体窝白膜完全脱落所需时间及住院时间均更短,术中失血量更少（P<0.05）。2组FLACC评分在组间、时点间及组间·时点间交互作用差异均有统计学意义（均P<0.05）。术后2周,2组T90、呼吸暂停事件次数、单次最长持续时间较术前下降,LSaO₂升高,差异均有统计学意义（均P<0.05）,且观察组改善情况优于对照组（P<0.05）。观察组QSQ评分高于对照组、OSA-18评分低于对照组（P<0.05）。观察组临床总有效率（98.18% vs. 88.24%）高于对照组,但差异无统计学意义（P>0.05）,并发症总发生率（3.64% vs. 13.73%）低于对照组,但差异无统计学意义（P>0.05）。2组均未发生严重并发症,所有不良事件均经妥善处理缓解,即在规范操作下,2种术式总体安全性良好。结论 鼻内镜下腺样体切除术联合CIT能更有效减轻患儿术后疼痛,促进短期恢复,改善呼吸功能与生活质量,且安全性良好。

Abstract

Objective To analyze the efficacy and safety of nasal endoscopic adenoidectomy with plasma ablation combined with coblation intracapsular tonsillectomy （CIT） for the treatment of pediatric obstructive sleep apnea （OSA）. Methods A total of 106 children with pediatric OSA scheduled for surgery between July 2024 and September 2025 were selected and divided into a control group （n=51, undergoing adenoidectomy with plasma ablation combined with tonsillectomy） and an observation group （n=55, undergoing adenoidectomy with plasma ablation combined with CIT） according to the surgical method. Perioperative indicators, pain behavior scales [face, legs, activity, cry, consolability scale （FLACC）] at 24, 48, and 72 h postoperatively, respiratory function [lowest oxygen saturation （LSaO₂）, the percentage of the total recorded time spent below 90% oxygen saturation （T90）, number of apnea events, and the longest single apnea duration] preoperatively and at 2 weeks postoperatively, and sleep and quality of life scores [Quebec Sleep Questionnaire （QSQ） and obstructive sleep apnea 18 items survey （OSA-18）] were compared between the two groups, to evaluate clinical efficacy and postoperative complications （secondary hemorrhage, fever, surgical site infection, and nasopharyngeal adhesions）. Results Compared with the control group, the observation group had a longer operative time, shorter time for complete shedding of the tonsillar fossa white membrane and shorter hospital stay, as well as less intraoperative blood loss （P<0.05）. The differences in FLACC scores between the two groups were statistically significant with respect to intergroup comparison, time points, and group-time interaction （all P<0.05）. At 2 weeks postoperatively, both groups showed a decrease in T90, number of apnea events, and the longest single apnea duration compared with preoperative levels, as well as an increase in LSaO₂, showing significant differences （all P<0.05）. Moreover, the improvement in the observation group was superior to that in the control group （P<0.05）. The observation group had a higher QSQ score and a lower OSA-18 score than the control group （P<0.05）. The clinical total effective rate in the observation group （98.18% vs. 88.24%） was higher than that in the control group, but the difference was not statistically significant （P>0.05）. The total incidence of complications （3.64% vs. 13.73%） was lower in the observation group than in the control group, but the difference was not statistically significant （P>0.05）. Conclusion Endoscopic adenoidectomy combined with CIT can reduce postoperative pain more effectively in children, promote short-term recovery, improve respiratory function and quality of life, and has good safety.

关键词

睡眠呼吸暂停,阻塞性 / CIT / 腺样体切除术

Key words

sleep apnea,obstructive / coblation intracapsular tonsillectomy / adenoidectomy