鼻内镜口腔途径选择性切除儿童肥大腺样体的手术技巧及疗效分析

摘要

目的 探讨鼻内镜下经口腔电动吸切选择性切除儿童肥大腺样体手术方式及疗效分析.方法 对有多种典型临床症状(包括打鼾、鼻塞、流脓涕、听力下降、口颌面部及生长发育畸形等)的56例腺样体肥大患儿,全麻下开口器撑开口腔并拉起软腭,经口腔插入70°鼻内镜显露鼻咽部肥大的腺样体,采用弯头正反向切割吸引刀头,明视下选择性吸切阻挡后鼻孔区的肥大腺样体部分,其余腺体组织保留,并与传统的盲刮法(79例)及鼻内镜下全切除法(25例)进行疗效比较.结果 本组全部患儿术后1～3天打鼾症状基本消失,未见术后并发症.手术创伤轻,出血少,患儿恢复快,经随访1～6个月,鼻部阻塞症状消失及明显改善49例(占87.5％),13例有耳部症状者治愈及明显好转者9例(占69.2％).而对照组盲刮法鼻症状改善有效率(62％),术后反应较重,出血较多;全切法有效率(84％),出血较多,术后反应较重.结论 采用鼻内镜经口明视下选择性吸切阻挡后鼻孔区的肥大腺样体部分,具有手术在明视下操作,术腔较宽敞、安全有效、微创、出血少及术后恢复快等优点,在众多的手术方法中是一种较为理想的选择术式.%Objective To explore method and effects of partial adenoidectomy via endoscopic oral approach for children with adenoid hypertrophy. Method Partial adenoidectomy (remove only a part of adenoids that obstructed region choanarum) were performed through oral cavity by nasal endoscope under general anaesthesia in 56 children with adenoid hypertrophy. The control groups applied blind scraping method with spatulas (79 cases) and thoroughly adenoidectomy method under nasal endoscope (25 cases). Typical symptoms and operative effects were compared between two groups. Results Snoring symptoms of all cases were disappeared after 1-3 days of operation, and without complications of slight surgical trauma and less bleeding. After a followup of 1-6 months, nasal obstruction were disappeared or obviously improved in 49 cases (87.5%) and otological symptoms were cured or obviously relieved in 9 of 13 cases (69.2%) . By contrast, blind scraping and thoroughly adenoidectomy showed efficacy on nasal obstruction in 62% and 84% cases respectively, but with severe post-operative reaction and more bleeding.Conclusion Partial adenoidectomy via endoscopic oral approach may be a better and ideal method for children with adenoid hyperthrophy. safety, less bleeding,convenient and micro-injure advantages.