Effects Of Different Surgical Procedures On Immunity Of Children With Obstructive Sleep Apnea Hypopnea Syndrome

Background:Obstructive Sleep Apnea Hypopnea Syndrom (OSAHS) refers to sleeping with repeated episodes of cessation of partial or total collapse on airway obstruction, which could lead to the insufficient ventilation and apnea, and the lack of oxygen and retention of carbon dioxide for a long time repeatedly as the characteristic, then this syndrom could cause growth retardation, cognitive dysfunction, and changes in both personality and behavior, even lead to cor pulmonale.Besides,it is the most common sleep disorder in children.Tonsillectomy with or without adenoidectomy is the main way of treatment, but both the tonsil and adenoid are important components of the pharyngeal lymphatic loop, playing an important role in humoral and cellular immune defense for children, and the follicular epithelium also constitutes the local immune barrier.At present, researches on the effects on immune function and the therapeutic effect of different tonsillectomy and adenoidectomy types for children are less.In recent years, plasma tonsil partial resection with the less reaction of pain and quick recovery is gradually used, and the operation can relieve airway obstruction and maximum retention of crypt epithelial barrier function has been gradually attracting people’s attention.Objective:To explore the effects of pure adenoidectomy, adenoidectomy thus partial tonsillectomy, and adenoidectomy thus total tonsillectomy on humoral and cellular immunity of children with obstructive sleep apnea hypopnea syndrome,and to discuss their indications respectively.Methods:This is a prospective clinical series study.1.One hundred and fifty cases of children who were suffering from Obstructive Sleep Apnea Hypopnea Syndrom diagnosed by polysomnography and being treated in Qilu Hospital were divided into 3 groups,including pure adenoidectomy group (group A) and adenoidectomy thus partial tonsillectomy group (group B), and adenoidectomy thus total tonsillectomy(group C),and there were 50 cases each group.2.Extracting 5 ml venous blood from all of the children on the first day after PSG and the 6th month after surgery respectively,and determine the IgQ IgA, IgM level in serum and peripheral blood T cell subgroup percentage.3.Calculating the incidence of complications such as chronic pharyngitis, record postoperative pain score,and observing tonsil grading, lining polysomnography, and recording the improvement of symptoms at postoperative 6 months.Results:1.There was no statistically significant difference compared with preoperative (P>0.05) in humoral immunity and cellular immunity index of postoperative 6 months.2.1n the 1st and 2nd day of postoperation,the pain score of A, B, C three groups significantly increased in turn(P<0.05), and in the 3rd postoperative day, pain score of group C was still obviously higher than that of A and B groups.3.There was no significant difference (P>0.05) in curative effect among three groups in the 6rd month post-operatively;There is one case reoperated because of tonsil hypertrophy in group A,two cases in group B,and none in group C.Conclusions:All of these three surgical procedures had no obvious effect on humoral and cellular immune function in children, and all of them could achieve the purpose of treating pediatric Obstructive Sleep Apnea Hypopnea Syndrom. Besides, tonsil resection or partial resection could be done or not according to the degree of hypertrophy.