儿童腺样体扁桃体切除术的免疫学后果：迷思、证据与未解问题

文献信息

中文摘要

扁桃体切除术是儿科人群中最常见的外科手术之一，主要适应证为复发性扁桃体炎和上气道阻塞。腭扁桃体是淋巴上皮结构，对局部和全身免疫监视至关重要，在淋巴细胞成熟和免疫球蛋白（尤其是分泌型IgA）产生中发挥关键作用。本综述总结了关于扁桃体切除术免疫学影响的现有证据，包括短期和长期研究。数据显示，切除扁桃体可导致免疫球蛋白和淋巴细胞水平的一过性变化，这通常与慢性炎症状态的缓解相关，而不损害整体免疫反应。临床研究还表明，其在减少复发性发热发作方面具有益处，例如在PFAPA综合征中。一些证据提示可能存在长期影响，如自身免疫性疾病或牙周疾病风险增加，尤其是在早期年龄接受干预时，尽管因果关系尚不明确。总之，按照选择性临床标准实施的扁桃体切除术在免疫学上总体似乎是安全的，并可能在局部或全身扁桃体功能障碍的情况下提供针对性的治疗获益。

英文摘要

Tonsillectomy is one of the most common surgical procedures in pediatric populations, indicated primarily for recurrent tonsillitis and upper airway obstruction. Palatine tonsils represent lymphoepithelial structures crucial for local and systemic immune surveillance, with a key role in lymphocyte maturation and the production of immunoglobulins, particularly secretory IgA. This review summarizes the available evidence on the immunological impact of tonsillectomy, including short- and long-term studies. Data show that tonsillar removal can result in transient changes in immunoglobulin and lymphocyte levels, often associated with resolution of a chronic inflammatory state, without compromising the global immune response. Clinical studies also indicate a benefit in reducing recurrent febrile episodes, such as in PFAPA syndrome. Some evidence suggests possible long-term effects, such as an increased risk of autoimmune or periodontal diseases, especially if the intervention is performed at an early age, although the causality is not yet clear. In conclusion, tonsillectomy performed according to selective clinical criteria generally appears immunologically safe and may provide targeted therapeutic benefits under conditions of local or systemic tonsil dysfunction.