#46
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Tonsillotomy in Children with Tonsillar Hypertrophy Ove Densert, Hilmi Desai, Alf Eliasson, Lone Frederiksen, Dan Andersson, Jan Olaison, Carl Widmark Abstract: Tonsillectomy is one of the most frequent surgical procedures carried out on children. Obstructive sleep apnea syndrome, caused by tonsillar hypertrophy, has been attracting increasing interest and tonsillectomy is often performed as a result of this indication. Regardless of the indication, the main aim of tonsillectomy has always been to remove the tonsils completely. The present study was undertaken in order to investigate the effect of two different surgical techniques, tonsillectomy and tonsillotomy, on clinical symptoms in children with symptoms of obstructive sleep apnea syndrome due to tonsillar hypertophy. The study was conducted as a prospective, randomized trial comparing the clinical effects of standard tonsillectomy and tonsillotomy using a CO2 laser. Forty-three children aged 2-9 years were included. Both groups of patients experienced comparable relief from symptoms of snoring and apneas at follow-up after 3 months and 2 years. There was no significant statistical difference between the two groups of patients in terms of both short- and long-term effects on clinical symptoms. Tonsillotomy caused no measurable bleeding during surgery. Postoperative pain and distress were less pronounced in the tonsillotomy group according to visual analog scale evaluations made by patients, parents and nursing staff. In conclusion tonsillotomy appears to be the less traumatic surgical method in cases of upper airway obstruction in children caused by tonsillar hypertrophy. Ïîêàçàíèÿ ê òîíçèëëýêòîìèè: http://www.sign.ac.uk/guidelines/fulltext/34/ http://www.entusa.com/tonsillectomy_surgery.htm http://health.allrefer.com/health/to...dications.html http://www.findarticles.com/p/articl...44/ai_11666488 http://www.emedicine.com/ent/topic315.htm http://www.utmb.edu/otoref/Grnds/Tan...TandA-9912.pdf |
#47
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Ïðîñòîé ïðèìåð èç èñòîðèè - â ÑØÀ â íà÷àëå 20 âåêà (åñëè íè÷åãî íå ïóòàþ, ìîæåò â ñåðåäèíå) ïîâàëüíî óäàëÿëè íåáíûå ìèíäàëèíû.  ðåçóëüòàòå ïîëó÷èëè ýïèäåìèþ ïîëèîìèåëèòà. À âîîáùå ýòî îôôòîï. ß âñåãî ëèøü Âàì ïûòàþñü îáúÿñíèòü: 1. Íàðêîç ýòî õîðîøî è â äåòñêîé ïðàêòèêå îí äîëæåí èñïîëüçîâàòüñÿ â ïîäàâëÿþùåì áîëüøèíñòâå ñëó÷àåâ. 2. Åñòü ñëó÷àè, êîãäà ì/à ïðèåìëåìà. 3. Ïîä ì/à ìîæíî âûïîëíèòü îïåðàöèþ êà÷åñòâåííî. 4. Àíåñòåçèîëîãè÷åñêèé ðèñê èìååò ìåñòî. Íàäî âñå âçâåøèâàòü. |
#48
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#49
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À âîò àäåíîòîìèÿ: 1. Âîçðàñò. Ñ 7-8 ëåò ìîæíî óæå äóìàòü î ì/à. 2. Êîíòàêòíûé, àäåêâàòíûé ðåáåíîê. 3. Àäåíîèäû ðàñïîëîæåíû íå î÷åíü íèçêî (ýòî óæå òåõíè÷åñêèé âîïðîñ). 4. Íåâîçìîæíîñòü íàðêîçà (ïî ìåäèöèíñêèì èëè ñîöèàëüíûì ïîêàçàíèÿì). 5. Îñóùåñòâëÿåòñÿ òîëüêî àäåíîòîìèÿ (áåç òîíçèëëîòîìèè è ò.ä.). Ó íàñ â îòäåëåíèè 80-90% ïîä îáùèì îáåçáîëèâàíèåì. |
#50
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Ïîèñêàâ ïî ðóíåòó, ïî ïàáìåä è ïî ãóãë íàñ÷åò ïîëèîìèåëèòà è òîíçèëýêòîìèè â ÑØÀ ïîëó÷èëà ñëåäóþùåå ìàññîâàÿ âàêöèíàöèÿ ïðîòèâ ïîëèîìèåëèòà ïåðîðàëüíîé âàêöèíîé â ÑØÀ íà÷àëàñü â 1961 ã Vaccine policy changes and epidemiology of poliomyelitis in the United States. JAMA. 2004 Oct 13;292(14):1696-701.  ïàáìåäå ìíîãî ñòàòåé ñ íàçâàíèÿìè òèïà "Ïîëèîìèåëèò è òîíçèëëýêòîìèÿ" îòíîñÿùèõñÿ ê 40-ì, 50-ì - íà÷àëó 60-õ ãîäîâ, íî ê ñîæàëåíèþ áåç àáñòðàêòîâ.  áðîøþðå ÂÎÇ ïî ïîâîäó óñïåõîâ ïðîôèëàêòèêè ïîëèîìèåëèòà (íà ðóññêîì) íà 21 ñòðàíèöå äåéñòâèòåëüíî óêàçàíî [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] (2 ìåãàáàéòà). "Íèêòî íå çíàåò, ïî÷åìó ïàðàëè÷ ðàçâèâàåòñÿ ëèøü ó íåçíà÷èòåëüíîé ÷àñòè èíôèöèðîâàííûõ ïîëèîâèðóñîì. Îäíàêî èçâåñòíî íåñêîëüêî âåäóùèõ ôàêòîðîâ ðèñêà, íàëè÷èå êîòîðûõ ïîâûøàåò âåðîÿòíîñòü ðàçâèòèÿ ïàðàëè÷à ó èíôèöèðîâàííîãî ÷åëîâåêà. Ê ÷èñëó òàêèõ ôàêòîðîâ îòíîñÿòñÿ: ° Èììóíîäåôèöèò ° Áåðåìåííîñòü ° Òîíçèëýêòîìèÿ ° Âíóòðèìûøå÷íûå èíúåêöèè ° ×ðåçìåðíûå ôèçè÷åñêèå íàãðóçêè ° Òðàâìû  ñòàòüå [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Pediatrics, Jan 1958, 94-105, Vol 21, No. 1 Copyright © 1958, American Academy of Pediatrics Incidence of cranial nerve paralysis in poliomyelitis in relation to presence or absence of tonsils; óêàçàíî, ÷òî "Tonsillectomy as a predisposing factor to contraction of poliomyelitis was mentioned as early as 1912 by Sheppard and attention was redirected to it by Ayer in 1928 and by Aycock and Luther in 1929." Òàêæå åñòü ññûëêè íà ýòó ñâÿçü íà ñàéòàõ ãîìåîïàòîâ è àíòèïðèâèâî÷íèêîâ, íî îíè íà ýòî íå îáðàùàþò âíèìàíèå, îáñóæäàÿ âðåä ïðèâèâêè ïðîòèâ ïîëèîìèåëèòà (êàê îáû÷íî. Ïèøóò, ÷òî ëó÷øå ïåðåáîëåòü ïîëèîìèåëèòîì, òê ó áîëüøèíñòâà ýòî ïðîòåêàåò êàê ãðèïï è òîëüêî íåêîòîðûå ñòàíîâÿòñÿ êàëåêàìè [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Èõ ñ äèòÿìè áû â ×å÷íþ ê íàì ïîæèòü, áåç ïðèâèâîê)  ãóãë íàøëîñü [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Tonsillitis ...In the 1950s the operation became less popular because of an outbreak of poliomyelitis. Patients who have had tonsillectomy are more susceptible to bulbar polio. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Acute Poliomyelitis ...Mortality/Morbidity: Of acute poliovirus infections, 4-8% show only nonspecific illness, and 1-2% of infections finally result in neurologic symptoms. The incidence of paralytic diseases increases with advancing age, recent hard exercise, tonsillectomy, pregnancy, and impairment of B-lymphocyte defenses. Ìîé âûâîä 1. Ïîêàçàíèÿ è ïðîòèâîïîêàçàíèÿ ê òîíçèëëýêòîìèè â íàñòîÿùåå âðåìÿ ñóùåñòâóþò è íèêòî íå ïðîâîäèò ïîãîëîâíîå óäàëåíèå ìèíäàëèí äåòÿì. 2. Ïîñëå ââåäåíèÿ íàöèîíàëüíîé ïðîãðàììû âàêöèíîïðîôèëàêòèêè ïðîòâ ïîëèîìèåëèòà ïðîáëåìà ïîëèîìèåëèòà ïîñëå òîíçèëëýêòîìèè èñ÷åçëà. Ïðèâèòûì îò ïîëèîìèåëèòà äåòÿì è âçðîñëûì òîíçèëëýêòîìèÿ íå ñòðàøíà 3. Õðàïÿùèå, òÿæåëîäûøàùèå äåòè ñ àäåíîèäíûì ëèöîì è ëåãêîé óìñòâåííîé íåäîñòàòî÷íîñòüþ èç-çà íåñâîåâðåìåííîãî óäàëåíèÿ ìèíäàëèí... http://forums.rusmedserv.com/showthr...6&page=1&pp=15 http://forums.rusmedserv.com/showthr...581#post111581 |
#51
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#52
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Ïî ñîöèàëüíûì ïîêàçàíèÿì - íàïðèìåð, íåâîçìîæíîñòü ôèíàíñèðîâàíèÿ óñëóã àíåñòåçèîëîãà.
Óâàæàåìûé, Ïàíäîê! Ñëèøêîì Âû íåãàòèâíî îòçûâàåòåñü î ìåñòíîé àíåñòåçèè. ß ñ Âàìè íå ñîãëàñåí. Íàðêîç âåäü òîæå íå áëàãî. Àíåñòåçèîëîãè÷åñêèé ðèñê âñåãäà èìååò ìåñòî. Çà÷åì íóæåí ðèñê?! Àäåíîòîìèÿ ëåò 30 íàçàä âîîáùå áûëà àìáóëàòîðíîé îïåðàöèåé. Åñòü êîíòèíãåíò ðîäèòåëåé, êîòîðûå êàòåãîðè÷åñêè îòêàçûâàþòñÿ îò íàðêîçà (íåñìîòðÿ íà òî ÷òî ó íèõ õâàòàåò ôèíàíñîâûõ âîçìîæíîñòåé). È òàêèõ ó íàñ äîñòàòî÷íî ìíîãî. |
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#53
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#54
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×òî åñòü áëàãî - íàðêîç èëè ì/à - ñóäèòü íå Âàì. Äëÿ ýòîãî ñóùåñòâóþò àíåñòåçèîëîãè. Àáñîëþòíîãî ïîíÿòèÿ áëàãà íå ñóùåñòâóåò, âñ¸ ðåøàåòñÿ â êîíòåêñòå. Àíåñòåçèîëîãè÷åñêèé ðèñê ñóùåñòâóåò, ýòî òî÷íî, íî ñìûñë àíåñòåçèè âîîáùå â òîì, ÷òî ìû îò ñòðåññà îïåðàöèîííîãî ñïàñàåì ñòðåññîì àíåñòåçèîëîãè÷åñêèì. Ýòî âå÷íàÿ ïðîáëåìà âûáîðà ìåíüøåãî èç äâóõ çîë. Íî îñòàâëÿòü â ñîçíàíèè ÷åëîâåêà, îñîáåííî ðåá¸íêà, êîòîðîìó ñîâåðøàþò ìàíèïóëÿöèè ÷åðåç ðîò/íîñ, îñòàâëÿòü åìó âîçìîæíîñòü äàæå ñëûøàòü ýòè çâóêè - èçóâåðñòâî. Î ïðîáëåìå çàùèòû âåðõíèõ äûõàòåëüíûõ ïóòåé óæå ò¸ðëè ìíîãî ðàç, ãëóïî ïèëèòü îïèëêè, íå äîõîäèò - ìû íå âèíîâàòû. |
#55
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͸áíûå ìèíäàëèíû òîæå ïîòîì ýêòîìèðîâàëè ïîä ì/à, íî óæå â 10 ëåò. Íå â âîñòîðãå. |
#56
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#57
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Õâàòèò êèäàòü â ìåíÿ òàïî÷êàìè!!! Ïîâòîðÿþ: îïåðàòèâíûå âìåøàòåëüñòâà íà ëèìôîãëîòî÷íîì êîëüöå äîëæíû ïðîâîäèòñÿ â äåòñêîé ïðàêòèêå ïîä íàðêîçîì. Íî åñòü ðÿä ñëó÷àåâ, êîãäà ì/à äîïóñòèìà è àäåíîòîìèþ ïîä ì/à ÌÎÆÍÎ âûïîëíèòü êà÷åñòâåííî! Ñêîëüêî ðàç áûëî - àíåñòåçèëîã ñìîòðèò áîëüíîãî - "Äàì íàðêîç, íî àíåñòåçèëîãè÷åñêèé ðèñê âûñîêèé". È ÷òî? Èäòè íà íàðêîç? Êîãäà ìîæíî ñäåëàòü õîðîøóþ ïðåìåäèêàöèþ è ñäåëàòü ïîä ì/à çà 1-2 ìèíóòû??? Öèòàòà:
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#58
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Âåðà/íåâåðèå èëè ñîìíåíèå/óâåðåííîñòü âåùü èððàöèîíàëüíàÿ è ñóãóáî ëè÷íàÿ. Ñîìíåâàéòåñü, åñëè õî÷åòñÿ.
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#59
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Äà íå ñïîðþ ÿ, ÷òî íàðêîç ýòî ïëîõî. Ýòî õîðîøî, íî â ÷åòêî îïðåäåëåííûõ ñëó÷àÿõ.
Ñâîèìè ïîñòàìè ÿ õî÷ó îáúÿñíèòü àíåñòåçèîëîãàì, ïàöèåíòàì è ò.ä.: 1. Ïîä ì/à ìîæíî êà÷åñòâåííî ñäåëàòü îïåðàöèþ; 2. Ì/à èìååò ìåñòî, ò.ê. èíîãäà áåçîïàñíåå äëÿ ïàöèåíòà, ÷åì íàðêîç. |
#60
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