Comparative Research On The Effect Of Unilateral/Bilateral Tonsillectomy In Children With OSAHS

Objective: The change on the reserved tonsillar morphology in children withOSAHS was observed in6-18months after unilateral tonsillectomy,the improvementof the quality of life and the variation of immunoglobulin and complement wasexplored for children with OSAHS in6-18months after unilateral tonsillectomy andbilateral tonsillectomy,which are used to analyse comparatively of the clinical valueundergoing unilateral tonsillectomy for children with OSAHS.Methods:40children with OSAHS were picked out, are demanded to meet the followingconditions:1. To accord the diagnostic criteria of the "guidelines for diagnosis andtreatment of children’s OSAHS draft" made by the Chinese Medical Association in2007.2.Ages from3years to8years old, their family is willing to cooperate withlong-term follow-up.3.It had continued for more than three months of snoring, mouthbreathing and sleep breath history.4.Checking:tonsil hypertrophy blockingpharyngeal cavity leaded to upper airway stenosis.5.40children were showed byelectron laryngoscopy and (or) CT that they had adenoid hypertrophy.6.It was deniedthe history of recurrent tonsillitis and other systemic diseases.According to theprinciple of balance and consider the willingness of family members,40children weredivided into two groups:20cases,unilateral tonsillectomy group (UT group);20cases,bilateral tonsillectomy group(BT group).The change of children’s throat andthe morphological changes of the remaining amygdala from20cases of OSAHSpatients in UT group was observed by electronic laryngoscopy; The improvement ofOSAHS in quality of life for children of UT group and BT group with OSA-18score was evaluated before and6months,12months,18months afteroperation.Peripheral venous blood in children of UT group and BT group was drawnbefore and6months,12months,18months after operation.Serum IgA, IgG,IgM and C3, C4levels were measured.Results:(1)The result of electronic laryngoscopy:2children were lost to follow-up.At6months, remained tonsils of all the patients were not seen obvious hypertrophy ascompared to preoperative period.Lateral pharyngeal bands had no significantchanges.At12months, remained tonsils of1patients became III degree as comparedto II degree at6months,and lateral pharyngeal bands also appeared hypertrophy.Theother patients had no significant changes.At18months,the preserved tonsil of the casethat had appeared hypertrophy in12months after operation is III degree. Remainedtonsils of another2cases had hypertrophy from preoperative just beyondpharyngopalatine arch in preoperative period to slightly beyond the midline.At thesame time,their lateral pharyngeal bands had obvious hypertrophy.Another15caseshad no obvious change.(2)The OSA-18score results:1.The total score showed no notable change betweengroup UT and group BT during the same period (P>0.05).In UT group and BT group,the total score at18months,at12months and at6months were decreased obviouslyas compared to preoperative operation (P<0.05). In UT group,the score at18monthswas reduced significantly(P=0.022<0.05),and the score in BT group at18months wasalso declined obviously as compared to6months(P=0.012<0.05).2.In two groups, thethree scores of sleep disturbance, physical symptoms and the influence to guardian at6months were statistically changed as compared to preoperative scores(P=0.000<0.01).When it came at12months or at18months,the scores which were ineither UT group or BT group of all the items in the questionnaire were sharply lowerthan the preoperative score,which showed significant difference (P=0.000<0.01);Thetwo scores of bad mood and daytime function at12months and at18months wereboth reduced contrasted with6months after operation (P=0.000<0.01).(3)The humoral immune function detection results: in two groups,the leve of IgG,IgM, IgA,C3and C4were slightly changed at6,12,18months after operation ascompared to preoperative period,there was no marked difference(P>0.05).Meanwhile,the level of serum immunoglobulins showed nosignificant difference between the two groups during the same period (P>0.05).Conclusions:(1)Two kinds of operation therapy can effectively relieve the oropharynx airway inchildren with OSAHS.(2)Two kinds of operation therapy can significantly improve the quality of life ofchildren with OSAHS.(3)Two kinds of operation therapy have no significant effect on children’s humoralimmune function.