Introduction

There is a growing interest in intra-capsular coblation tonsillectomy (ICT) for the treatment of obstructive sleep apnea (OSA) in children. Literature remains controversial regarding which intra-capsular tonsillectomy (IT) technique is most effective and with least morbidity. Therefore, the aims of this study are to objectively measure the post-operative morbidity and the effectiveness of the ICT technique.

Materials and methods

107 children undergoing ICT (with or without adenoidectomy) for upper airway obstruction due to tonsillar hypertrophy at a tertiary center university hospital were prospectively enrolled from March 2016 to March 2018. Efficacy of the surgery was assessed by a pre-and post-operative Obstructive Sleep Apnea score (OSA-18). Post-operative morbidity was measured based on the Parent's Post-operative Pain Measure questionnaire (PPPM), type and duration of administered pain medication, time before resuming a full diet and a normal activity, readmission for dehydration and post-operative bleeding incidence.

Results

After a mean follow-up of 21.6 months, OSA-18 mean total score was 78.77 (SD = 15.74) before ICT and 23.7 (SD = 9.25) after surgery, with a significant difference between pre-operative and post-operative scores (p < 0.001). Mean PPPM scores were low at all evaluation points (5.89, 2.42 and 0.83 at days 2, 5 and 10 respectively). Analgesic use was restricted to acetaminophen in nearly all children for a mean duration of 1.93 days. They resumed a normal diet after 2.42 days and a normal activity (including return to school) after 2.7 days. No hospital readmission nor post-operative hemorrhage were reported.

Conclusion

Intra-capsular tonsillectomy by coblation is an effective and safe procedure that provides rapid post-operative recovery with minimal analgesic requirements, thus deserving a wider application in treating upper airway obstruction due to tonsillar hypertrophy in children.

中文翻译：

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消融囊内扁桃体切除术：一项前瞻性三级中心试验

介绍

对用于治疗儿童阻塞性睡眠呼吸暂停 (OSA) 的囊内消融扁桃体切除术 (ICT) 越来越感兴趣。关于哪种囊内扁桃体切除术 (IT) 技术最有效且发病率最低，文献仍存在争议。因此，本研究的目的是客观地衡量术后发病率和 ICT 技术的有效性。

材料和方法

2016 年 3 月至 2018 年 3 月，前瞻性招募了 107 名在三级中心大学医院因扁桃体肥大而接受 ICT（有或无腺样体切除术）的上气道阻塞的儿童。手术的疗效通过术前和术后阻塞性睡眠评估呼吸暂停评分 (OSA-18)。根据父母的术后疼痛测量问卷 (PPPM)、所用止痛药的类型和持续时间、恢复完全饮食和正常活动前的时间、脱水再入院和术后出血发生率来测量术后发病率。

结果

平均随访 21.6 个月后，ICT 前 OSA-18 平均总分为 78.77（SD = 15.74），手术后为 23.7（SD = 9.25），术前和术后评分有显着差异（p < 0.001)。所有评估点的平均 PPPM 分数均较低（第 2、5 和 10 天分别为 5.89、2.42 和 0.83）。几乎所有儿童的镇痛药使用仅限于对乙酰氨基酚，平均持续时间为 1.93 天。他们在 2.42 天后恢复正常饮食，在 2.7 天后恢复正常活动（包括返校）。未报告再入院或术后出血。

结论

通过消融进行的囊内扁桃体切除术是一种有效且安全的手术，可提供快速的术后恢复和最少的镇痛需求，因此值得更广泛地应用于治疗儿童扁桃体肥大引起的上气道阻塞。