腭裂儿童行扁桃体切除术伴或不伴腺样体切除术的术后结局：范围综述

文献信息

中文摘要

背景： 扁桃体切除术伴或不伴腺样体切除术（AT/T）是美国最常见的儿童外科手术之一，但其在腭裂儿童中的结局特征尚不明确，文献中对风险特征尚无共识。本范围综述旨在检查和综合该人群中AT/T术后功能结局和术后并发症的现有证据。方法：检索了PubMed、Embase、Web of Science和Cumulative Index to Nursing and Allied Health Literature数据库，研究选择按照系统评价和Meta分析扩展版范围综述指南的首选报告项目进行报告。纳入同行评议文章，报告18岁以下有腭裂修复史（在AT/T之前或同时进行）患者AT/T的术后结局。所描述的结局包括与睡眠呼吸障碍、听力损失、感知言语特征和腭咽功能相关的结局。结果：在确定的672项独特研究中，16项研究符合纳入标准。确定的术后趋势包括睡眠呼吸障碍改善（9项研究中的6项[66.7%]）、言语结局通常稳定或改善，以及术后腭咽功能不全发生率低。一些证据表明，AT/T可能有助于减少该人群的传导性听力损失。手术并发症发生率报告不频繁，且研究间差异很大。结论：研究结果表明，AT/T并未显示出术后不良结局的高风险，并可能对腭裂儿童患者有益。然而，现有证据有限，且结局似乎比一般儿童人群更难以预测，这强调了在腭裂儿童中做出手术决策时进行彻底个体化评估的必要性。

英文摘要

BackgroundTonsillectomy with or without adenoidectomy (AT/T) is among the most common pediatric surgical procedures performed in the United States, but its outcomes in children with cleft palate are poorly characterized, with no consensus in the literature on risk profile. This scoping review examines and synthesizes the available evidence on functional outcomes and postoperative complications following AT/T in this population.MethodsPubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases were searched, and study selection was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews guidelines. Peer-reviewed articles reporting postoperative outcomes of AT/T in patients under 18-years-old with a history of cleft palate repair, performed either before or concurrently with AT/T, were included. Outcomes characterized included those relating to sleep-disordered breathing, hearing loss, perceptual speech characteristics, and velopharyngeal competency.ResultsOf 672 unique studies identified, 16 studies met the criteria for inclusion. Postoperative trends identified included improvements in sleep-disordered breathing (6 of 9 [66.7%] studies), generally stable or enhanced speech outcomes, and low rates of postoperative velopharyngeal insufficiency. Some evidence indicates that AT/T may provide benefit in reducing conductive hearing loss in this population. Surgical complication rates were reported infrequently and were highly variable among studies.ConclusionsFindings suggest that AT/T does not demonstrate a high risk of adverse postoperative outcomes and may provide benefit in pediatric patients with cleft palate. However, the available evidence is limited, and outcomes appear less predictable than in the general pediatric population, underscoring the necessity of thorough individualized assessment when making surgical decisions in children with cleft palate.