低温等离子囊内扁桃体切除术治疗儿童阻塞性睡眠呼吸障碍的结局：一项新加坡研究

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中文摘要

引言： 与囊外扁桃体切除术相比，低温等离子囊内扁桃体切除术（ICT）可能为儿童阻塞性睡眠呼吸障碍（oSDB）提供更有利的术后并发症情况。来自新加坡儿童人群的数据仍然有限。本研究考察了在新加坡一家三级中心接受低温等离子ICT治疗的oSDB儿童的结局。
方法： 这是一项单中心前瞻性队列研究，纳入102例连续儿童，年龄21个月至15岁，因oSDB接受低温等离子ICT（2023年4月至10月）。98.0%的患者同时接受了腺样体切除术。主要结局包括并发症和疾病特异性生活质量（QoL），通过阻塞性睡眠呼吸暂停-18生活质量（OSA-18）问卷评估（评分越高表示症状负担越重、生活质量越差），在术前和3个月时进行评估。次要结局包括疼痛、镇痛、饮食和打鼾缓解情况。
结果： 未发生术后出血或重大并发症。所有102例患者均完成了3个月复查。中位OSA-18评分从术前的74（四分位距[IQR] 54-89）显著改善至术后的29.5（IQR 23-40）（P<0.001），代表从中度影响区间转变为极低影响区间。平均变化39.3分超过了已发表的最小临床重要差异的两倍（标准化反应均数2.17）。感知QoL评分从中位数5（IQR 4-6.6）改善至8（IQR 8-9）（P<0.001）。在3个月时，82.4%无打鼾。术后疼痛轻微，75.5%需要镇痛3天或更短。
结论： 在这项非对照单臂队列中，低温等离子ICT联合同期腺样体切除术与低并发症发生率以及照护者报告结局的临床意义改善相关。这些产生假设的发现值得通过更长随访的多中心比较研究进一步调查。

英文摘要

INTRODUCTION: Coblation intracapsular tonsillectomy (ICT) may offer a more favourable post-operative morbidity profile compared with extracapsular tonsillectomy for paediatric obstructive sleep-disordered breathing (oSDB). Data from the Singapore paediatric population remain limited. This study examines the outcomes of coblation ICT in children with oSDB at a tertiary centre in Singapore.
METHOD: This was a single-centre prospective cohort study of 102 consecutive children aged 21 months to 15 years undergoing coblation ICT for oSDB (April-October 2023). Concurrent adenoidectomy was performed in 98.0% of patients. Primary outcomes included complications and disease-specific quality of life (QoL) via the Obstructive Sleep Apnea-18 Quality of Life (OSA-18) questionnaire (where higher scores indicate greater symptom burden and poorer quality of life), assessed pre-operatively and at 3 months. Secondary outcomes included pain, analgesia, diet, and snoring resolution.
RESULTS: No post-operative haemorrhage or major complications occurred. All 102 patients completed a 3-month review. The median OSA-18 score improved significantly from 74 (interquartile range [IQR] 54-89) to 29.5 (IQR 23-40) post-operatively (P<0.001), representing a shift from the moderate to the minimal impact band. The mean change of 39.3 points exceeded twice the published minimal clinically important difference (standardised response mean 2.17). Perceived QoL score improved from median 5 (IQR 4-6.6) to 8 (IQR 8-9) (P<0.001). At 3 months, 82.4% had no snoring. Postoperative pain was mild, with 75.5% requiring analgesia for 3 days or fewer.
CONCLUSION: In this uncontrolled single-arm cohort, coblation ICT with concurrent adenoidectomy was associated with low morbidity and clinically meaningful improvements in caregiver-reported outcomes. These hypothesis-generating findings warrant further investigation through multicentre comparative studies with longer follow-up.