扁桃体部分切除术与全切术对阻塞性睡眠呼吸暂停低通气综合征患儿炎症及免疫功能的比较研究OA

OBJECTIVE To compare and analyze the effects of partial tonsillectomy versus total tonsillectomy on postoperative secondary bleeding,inflammation,and immune function in children with obstructive sleep apnea hypopnea syndrome(OSAHS).METHODS There are 136 children with OSAHS admitted to Tangshan Maternal and Child Health Hospital from June 2021 to June 2023 were selected.Random number table method was used to divide them into two groups,A and B,68 cases each.Total tonsillectomy and adenoidectomy were performed in group A,and partial tonsillectomy and adenoidectomy were performed in group B.The perioperative indicators and postoperative secondary bleeding were analyzed.The levels of inflammatory factors were detected 1 week after surgery,the apnea hypopnea index(AHI)and minimum arterial oxygen saturation(LSaO2)were evaluated 3 months after surgery,and the indexes of immune function were detected.The patients were followed up for 6 months after operation,and the postoperative infection and recurrence were analyzed.RESULTS Compared with group A,the operation time of group B was shortened,the amount of intraoperative blood loss was reduced,and the grading score of postoperative facial expression was decreased(P<0.05).There was no statistical significance in the length of hospital stay between the two groups(P>0.05).The incidence of postoperative secondary bleeding in group A was 14.71%was higher than 4.41%in group B(P<0.05).The occurrence time of secondary bleeding in group A was(3.80±1.32)days after surgery,which was significantly shorter than that in group B(5.67±1.15)days after surgery(P<0.05).The levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and highly sensitive C-reactive protein(hs-CRP)in both groups were decreased after surgery(P<0.05),and the levels of IL-6,TNF-α and hs-CRP in group B were decreased after surgery compared with group A(P<0.05).Compared with the preoperative results,AHI level decreased and LSaO2 level increased in the two groups after surgery(P<0.05),and there was no statistical significance in AHI and LSaO2 levels between the two groups(P>0.05).There was no significant difference in surgical immunoglobulin(Ig)A,IgG and IgM between the two groups(P>0.05).Compared with group A,the levels of IgA,IgG and IgM in group B were increased(P<0.05).There was no significant difference in the bleeding site between group A and Group B(P>0.05),and there was no significant difference in the postoperative infection rate and recurrence rate between group A and group B(P>0.05).CONCLUSION Partial or complete removal of tonsils can improve breathing during OSAHS sleep,and the long-term effect is similar.However,partial resection can shorten the operation time,reduce the amount of intraoperative blood loss and postoperative pain,effectively reduce postoperative secondary bleeding,and improve the body's inflammatory response,which is conducive to the recovery of postoperative immune function in children with higher safety.