腺样体肥大引起相关疾病的临床分析

发布时间：2018-05-05 02:46

本文选题：腺样体肥大 + 鼻内镜腺样体切除术　；参考：《苏州大学》2010年硕士论文

【摘要】： 腺样体又称咽扁桃体、增殖体,位于鼻咽顶后壁,是咽淋巴环一部分,属于人体的免疫器官,含有各个发育阶段的淋巴细胞。腺样体于出生后逐渐增大,2-10岁为生理性肥大,6岁时最大,10岁后逐渐萎缩、青春期前逐渐消失。当受各种细菌、病毒等上呼吸道感染时,增生肥大出现相应症状,如夜间打鼾、张口呼吸、鼻塞、鼻溢,听力下降时称为腺样体肥大[1]。腺样体肥大多见于儿童及青少年,部分成人亦可发生,常合并慢性扁桃体炎,手术是其治疗的主要手段[2]。腺样体肥大可以引起儿童慢性鼻窦炎、分泌性中耳炎、儿童阻塞性睡眠呼吸暂停低通气综合征等并发症[3,4]。腺样体肥大可引起组织器官缺血缺氧,导致多器官功能损害,特别是对肺、心脑血管的损害[5]。腺样体切除术已成为治疗的重要手段。腺样体切除有两个观念值得注意:第一,当患儿出现腺样体肥大且伴有合并症时才是切除的指征。第二,肥大的腺样体才是一定有病的腺样体。腺样体肥大是正常腺样体对抗原刺激的一种反应,而腺样体慢性感染时,常伴有并发症的出现,但腺样体却并不肥大,因为它不能产生免疫反应。并且腺样体的致病菌与分泌性中耳炎、鼻窦炎的致病菌基本相似。主要菌群为溶血性链球菌、流感嗜血杆菌。因此,是否需要进行腺样体切除应根据合并症的严重程度及持续时间。我们认为腺样体切除治疗对相关疾病的转归是有效的。研究目的:探讨腺样体肥大与分泌性中耳炎、鼻-鼻窦炎及小儿鼾症的关系,以及腺样体切除术手术方法及对相关疾病术后疗效的分析。研究方法:选择2008年8月-2009年9月在安徽省黄山市人民医院住院的病例,腺样体肥大并有手术指证的患者术前检查,包括鼻内镜、声导抗、血液检查、胸部摄片及心电图检查。行腺样体手术,术后定期随访,询问病人主观症状,复查鼻内镜、声导抗,较大患者术前、术后查电测听,了解术后恢复状况及有无并发症。结果:45例腺样体肥大患儿,合并分泌性中耳炎26例,合并鼾症35例,合并鼻窦炎19例,合并扁桃体肥大12例,腺样体大小与三种并发症分布两两有差异,有统计学意义(P 0.05)。腺样体大小与三型鼻窦炎两两分布无差异,无统计学意义(P0.05)。术后随访1～3个月,鼻塞、鼻漏、打鼾、听力症状改善有效率分别为90%、89.3%、97.1%、85.7%。腺样体切吸术后,中耳炎治愈率80.8%,声导抗术前B、C型转为术后A型,术后经X2检验,有统计学意义(P0.01)。结论:腺样体肥大可并发分泌性中耳炎、鼻-鼻窦炎及鼾症。鼻内镜下腺样体切除术术野清晰,切除范围准确,手术方法易掌握,腺样体切除术对患儿疾病的转归疗效肯定。
[Abstract]:Adenoid, also called pharyngeal tonsil, is located in the posterior wall of nasopharynx, is a part of the pharyngeal lymphatic ring, belongs to the immune organs of the human body and contains lymphocytes in various stages of development. The adenoids gradually increased after birth and became physiologically hypertrophic at the age of 2 to 10. The largest adenoid was atrophied after 6 years of age and disappeared before puberty. When infected by various bacteria, viruses and other upper respiratory tract infections, hyperplastic hypertrophy appears corresponding symptoms, such as nocturnal snoring, open mouth breathing, nasal congestion, nasal overflow, hearing loss called adenoid hypertrophy [1]. Adenoid hypertrophy is more common in children and adolescents, some adults can also occur, often associated with chronic tonsillitis, surgery is the main means of its treatment [2]. Adenoid hypertrophy may cause complications such as chronic sinusitis, secretory otitis media and obstructive sleep apnea hypopnea syndrome in children. Adenoid hypertrophy can lead to ischemia and hypoxia of tissues and organs, leading to multiple organ function damage, especially to lung, cardiovascular and cerebrovascular damage [5]. Adenoidectomy has become an important means of treatment. Adenoidectomy has two ideas to be noted: first, adenoid hypertrophy is the indication of adenoidectomy in children with complications. Second, hypertrophic adenoids must be diseased adenoids. Adenoid hypertrophy is a normal adenoid response to antigen stimulation, and adenoid chronic infection often accompanied by complications, but adenoid is not hypertrophy, because it can not produce immune response. The pathogenic bacteria of adenoid are similar to those of secretory otitis media and sinusitis. The main bacteria was Streptococcus haemolyticus and Haemophilus influenzae. Therefore, the need for adenoidectomy should be based on the severity and duration of the complication. We believe that adenoidectomy is effective for the outcome of related diseases. Objective: to investigate the relationship between adenoid hypertrophy and secretory otitis media, rhinosinusitis and snoring in children. Methods: patients who were hospitalized in Huangshan people's Hospital from August 2008 to September 2009 were selected for preoperative examination of adenoid hypertrophy including nasal endoscopy acoustic conductance blood examination chest radiography and electrocardiogram. The patients were followed up regularly after adenoidectomy. The subjective symptoms of the patients were inquired, nasal endoscopy and acoustic impedance were rechecked, and the patients were examined with electric audiometry before and after operation to find out the recovery status and the complications. Results among 45 children with adenoid hypertrophy, 26 were complicated with secretory otitis media, 35 with snoring, 19 with sinusitis and 12 with tonsil hypertrophy. The size of adenoid was significantly different from the distribution of three complications (P 0.05). There was no significant difference between the size of adenoids and the distribution of sinusitis type III (P 0.05). The effective rates of nasal obstruction, rhinorrhea, snoring and hearing symptom improvement were 99.3% and 85.7% respectively. After adenoidectomy, the cure rate of otitis media was 80.8, and the acoustic conductance was changed to type A before operation. After X2 test, there was statistical significance (P 0.01). Conclusion: adenoid hypertrophy may be associated with secretory otitis media, rhinosinusitis and snoring. Adenoidectomy under nasal endoscope is clear in field, accurate in scope and easy to master. Adenoidectomy is effective in the outcome of disease in children.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R766

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