小儿腺样体、扁桃体切除术.pptVIP

小儿腺样体、扁桃体切除术（一） 为什么强调小儿？ 美国2011年版儿童扁桃体切除术临床实践指南 该指南适用于1—18岁可能需行扁桃体切除术的患儿； Removal of the tonsils and adenoids is thought to be the bread and butter of pediatric otolaryngology. The current controversial issue is focused on pediatric tonsillectomy, a surgical procedure that is learned early during specialist training and performed by almost all otolaryngologists worldwide. Having a closer look at the history of tonsillectomy, it becomes quickly clear that barely any other ENT surgery has undergone so many changes regarding the frequency, indication and technique as tonsillectomy did. Indications of Pediatric Tonsillectomy At the beginning of the 20th century, recurrent tonsillitis was the main reason for removal of the tonsils. TA represented 30–50% of all pediatric surgeries in the 1930s The advent of antibiotics in the 1950s resulted in a dramatic decrease in the overall number of tonsillectomies. In the USA, the frequency dropped from 1,400,000 TAs per year in 1959 to 500,000 in 1979, In the UK, 200,000 tonsillectomies per year in 1930 to 50,000 at the beginning of the 21st century The series published during the last 30 years show a clear shift in the indications of tonsillectomy. Sleep-disordered breathing is now the main reason for TA in children. All studies published in the last few years show this trend, which is even more obvious in children under 3 years of age, where OSAS reaches 90–100% of indications. In older children, infections are more frequent indications for TA Tonsillectomy: A Simple Surgical Procedure ? Austrian events：The death of 5 children in Austria below the age of 6 years due to posttonsillectomy haemorrhage in 2006 and 2007 showed how quickly medical procedures can be discussed and debated by the media and politicians As a consequence, the Austrian Pediatric and ENT Societies had to revise and tighten the guidelines for adenotonsillectomy The main aim is to restrict tonsillectomies to cases where the complete tonsil has to be dissecte