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Neue Techniken der Tonsillenchirurgie beim obstruktiven Schlafapnoe-Syndrom des Kindes

New techniques of tonsil surgery in children with obstructive sleep apnea syndrome

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Zusammenfassung

Therapie der Wahl beim obstruktiven Schlafapnoe-Syndrom (OSAS) des Kindes war bis vor wenigen Jahren die Tonsillektomie mit Adenotomie. Der vorliegende Artikel gibt anhand einer Literaturrecherche einen Überblick über neuere Techniken der Tonsillenchirurgie, insbesondere der Tonsillotomie, und deren Auswirkungen auf die polysomnographisch erfassten Atemparameter. Während mit der Tonsillektomie und Adenotomie Heilungsraten von 85% erzielt werden, liegen die Heilungsraten nach Tonsillotomie und Adenotomie abhängig vom Operationsverfahren bei 50–93%. Deutlich schlechtere Heilungsraten nach Tonsillektomie zeigen jüngere und übergewichtige Kinder sowie Kinder mit einem ungünstigen Ausgangsbefund in der Polysomnographie. Insgesamt ist die Datenlage jedoch noch sehr schwach, so dass prospektive Vergleichsstudien mit den verschiedenen Techniken zu fordern sind, bis eine endgültige Empfehlung herausgegeben werden kann. Unabhängig davon, bietet die Tonsillotomie gegenüber der Tonsillektomie den Vorteil der geringeren postoperativen Nachblutungsgefahr sowie den geringeren postoperativen Schmerzen. Ein Nachwachsen der Rest-Tonsillen nach Tonsillotomie ist jedoch möglich und kann zu erneuten Beschwerden der Kinder führen.

Abstract

Until a few years ago the therapy of choice in the treatment of obstructive sleep apnea in children consisted of tonsillectomy with adenoidectomy. Based on the literature this article provides an overview about new techniques in tonsil surgery, particularly with regard to tonsillotomy, and their impact on respiratory parameters obtained by nocturnal polysomnography. While tonsillectomy with adenoidectomy can heal up to 85% of the children, tonsillotomy with adenoidectomy can be successful in 50–93% depending on the operative technique. Even lower percentages were seen in young and obese children after tonsillectomy as well as in children with severe findings in preoperative polysomnography. Overall, more prospective studies comparing different operative techniques are required before final recommendations can be made. Independent of this fact, tonsillotomy offers less postoperative bleeding and pain than tonsillectomy even though the risk of regrowth after tonsillotomy exists.

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  1. Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- Halschirurgie, Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    R. de la Chaux, M. Patscheider, E. Krause & A. Dreher

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de la Chaux, R., Patscheider, M., Krause, E. et al. Neue Techniken der Tonsillenchirurgie beim obstruktiven Schlafapnoe-Syndrom des Kindes. Somnologie 13, 161–169 (2009). https://doi.org/10.1007/s11818-009-0416-6

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