Objective To compare the advantages and disadvantages of four approaches for minimally invasive adenoidectomy so that to determine the best clinical surgical approach. Methods Children with Ⅲ - Ⅳ degree adenoidal hypertrophy, who were admitted to our hospital from January 2008 to June 2012, received endoscopic resection via transnasal or transoral approaches. Powered debrider and radiofrequency were applied in each of the approach. The patients were divided into four groups (group A; transnasal debrider, group B: transoral debrider, group C: transnasal radiofrequency, group D: transoral radiofrequency) according to the request of the patients' family (30 children in each) and were followed up for 6 months. Results Both Groups A and B showed significantly more bloods loss and longer operation time than that group C , followed by group D ( F = 324. 5 and 455. 5 , P =0. 000). No significant difference was found between groups A and B in bloods loss and operation time (P =0. 189 and 0.997). The rate of postoperative nasal obstruction and intraoperative injury to the nasal cavity mucosa in group C was higher than that of group A (χ2 = 7. 200, P = 0. 007 and χ2 =4. 286 , P = 0. 038). There was no significant difference in postoperative soft palate edema between the two transoral groups (χ2 =0. 000, P = 1. 000). No significant difference was found in the incidence rate of headache during the first postoperative week among the four groups (χ2 = 7. 059 , P = 0. 070). No non-effective case was found at the end of 6-month follow-up, and no significant difference was found in cure rate nor in the rate of adenoidal residue among the four groups (χ2 =2. 182, P = 0.536 and χ2 = 1.617, P - 0. 655). There were no headache or Eustachian tube orifice occlusion occurred in any of the groups, and ear fullness disappeared in all the patients in the four groups. The rate of nasal cavity adhesion was higher in group C than that in the other three groups (χ2 =19.730, P= 0.000) , no significant difference was found among groups A, B and D (P>0.05). Conclusions Satisfactory results were achieved with all the four approaches for minimally invasive endoscopic adenoidectomy with different advantages and disadvantages. Radiofrequency ablation shortens the operation time and decreases intraoperative blood loss comparing to powered debrider, but it has a long learning curve and needs more practice. Transoral endoscopic frequency adenoidectomy provides a wider visual field, but it' s harder to determine the ablation depth. Transnasal adenoidectomy has a direct visual field and is easy to learn, but adhesion and adenoidal residue should be avoided.%目的 比较4种鼻内镜下微创腺样体切除术式的优缺点,为临床腺样体术式选择提供参考. 方法 2008年1月～2012年6月,选择Ⅲ～Ⅳ度腺样体肥大患儿,分别在鼻内镜下采用经鼻、经口2种入路切除,每种入路采用电动吸切器或低温等离子刀2种工具切除.按家属意愿分为4组,A组为经鼻、电动吸切器,B组为经口、电动吸切器,C组为经鼻、低温等离子,D组为经口、低温等离子,各30例,并随访6个月. 结果 手术时间和术中出血量均为A、B组＞C组＞D组(F=324.5、455.5,P均=0.000),A、B组间差异无显著性(P =0.189、0.997).2个经鼻手术组的术中鼻腔黏膜创伤和术后鼻塞的发生率C组明显高于A组(x2 =7.200,P=0.007;x2 =4.286,P=0.038).2个经口手术组的软腭水肿的发生率差异无显著性(X2=0.000,P=1.000).4组间术后1周内头痛的发生率差异无显著性(x2=7.059,P=0.070).术后6个月4组疗效均为治愈或有效,均无无效病例,4组治愈率差异无显著性(x2=2.182,P=0.536).4组腺样体残留的发生率差异无显著性(x2=1.617,P=0.655).4组均无头痛及咽鼓管口闭锁发生,耳闷症状均消除.鼻腔粘连率C组明显高于其他3组(x2=19.730,P =0.000),A、B、D组间差异无显著性(P＞0.05). 结论 鼻内镜下4种腺样体微创切除术均能取得满意效果,但各有利弊.低温等离子切除较电动吸切器出血少,手术时间短,但学习曲线较长,技巧性较高.经口鼻内镜下腺样体切除术视野开阔,但切除深度不易把握；经鼻切除视野直观,简便易学,但应尽量避免术后鼻腔粘连和腺样体残留.
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