Tổng quan về kết quả phẫu thuật cắt amidan trong bao ở trẻ em
Nội dung chính của bài viết
Tóm tắt
Phẫu thuật cắt amidan trong bao ngày càng được quan tâm như một lựa chọn thay thế cho cắt amidan toàn phần ở trẻ em, nhằm giảm đau và biến chứng hậu phẫu. Nghiên cứu thực hiện tổng quan luận điểm theo hướng dẫn PRISMA-ScR trên PubMed, Cochrane Library và Google Scholar nhằm tổng hợp các bằng chứng về kết quả lâm sàng của kỹ thuật này ở bệnh nhi 0 - 18 tuổi. Phân tích 16 nghiên cứu cho thấy cắt amidan trong bao có xu hướng giảm đau sau mổ, rút ngắn thời gian hồi phục và giảm tỷ lệ chảy máu thứ phát so với cắt ngoài bao. Một số nghiên cứu ghi nhận hiệu quả cải thiện OSA/SDB không khác biệt đáng kể so với cắt ngoài bao, với tỷ lệ phẫu thuật lại thấp. Nguy cơ phẫu thuật lại cao hơn ở trẻ nhỏ và nhóm có bệnh lý nền phức tạp. Phẫu thuật cắt amidan trong bao có ưu thế về hồi phục hậu phẫu và giảm biến chứng chảy máu ở nhóm bệnh nhi phù hợp.
Chi tiết bài viết
Từ khóa
Cắt amidan trong bao, hội chứng ngưng thở khi ngủ ở trẻ em, tổng quan luận điểm
Tài liệu tham khảo
1. Mitchell RB, Archer SM, Ishman SL, et al. Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg. 2019;160(1 Suppl):S1-S42. doi:10.1177/0194599818801757
2. Parker NP, Walner DL. Trends in the indications for pediatric tonsillectomy or adenotonsillectomy. Int J Pediatr Otorhinolaryngol. 2011;75(2):282-285. doi:10.1016/j.ijporl.2010.11.019
3. Koltai PJ, Solares CA, Koempel JA, et al. Intracapsular tonsillar reduction (partial tonsillectomy): reviving a historical procedure for obstructive sleep disordered breathing in children. Otolaryngol Head Neck Surg. 2003;129(5):532-538. doi:10.1016/S0194-5998 (03)00727-7
4. Walton J, Ebner Y, Stewart MG, April MM. Systematic review of randomized controlled trials comparing intracapsular tonsillectomy with total tonsillectomy in a pediatric population. Arch Otolaryngol Head Neck Surg. 2012;138(3):243-249. doi:10.1001/archoto.2012.16
5. Isaacson G, Parikh T. Developmental anatomy of the tonsil and its implications for intracapsular tonsillectomy. Int J Pediatr Otorhinolaryngol. 2008;72(1):89-96. doi:10.10 16/j.ijporl.2007.09.021
6. Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg. 2005;132(2):281-286. doi:10.1016/j.otohns.2004.09.007
7. Sagheer SH, Kolb CM, Crippen MM, et al. Predictive pediatric characteristics for revision tonsillectomy after intracapsular tonsillectomy. Otolaryngol Head Neck Surg. 2022;166(4):772-778. doi:10.1177/01945998211034454
8. Doshi HK, Rosow DE, Ward RF, April MM. Age-related tonsillar regrowth in children undergoing powered intracapsular tonsillectomy. Int J Pediatr Otorhinolaryngol. 2011;75(11):1395-1398. doi:10.1016/j.ijporl.20 11.07.036
9. Zhang Q, Li D, Wang H. Long term outcome of tonsillar regrowth after partial tonsillectomy in children with obstructive sleep apnea. Auris Nasus Larynx. 2014;41(3):299-302. doi:10.1016/j.anl.2013.12.005
10. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. doi:10.7326/M18-0850
11. Wang J, Dang PH, Chang HH, Wang ZH. Subtotal intracapsular tonsillectomy may be the first choice for tonsillectomy in children. J Int Med Res. 2021;49(5):3000605211011930. doi:10.1177/03000605211011930
12. Rinot E, Eisenbach N, Yakubovich I, et al. Intracapsular tonsillectomy improves children’s postoperative behavior measures. Int J Pediatr Otorhinolaryngol. 2025;191:112279. doi:10.1016/j.ijporl.2025.112279
13. Hultcrantz E, Ericsson E. Pediatric tonsillotomy with the radiofrequency technique: less morbidity and pain. Laryngoscope. 2004;114(5):871-877. doi:10.1097/00005537-200405000-00016
14. Derkay CS, Darrow DH, Welch C, Sinacori JT. Post-tonsillectomy morbidity and quality of life in pediatric patients with obstructive tonsils and adenoid: microdebrider vs electrocautery. Otolaryngol Head Neck Surg. 2006;134(1):114-120. doi:10.1016/j.otohns.2005.10.039
15. Lister MT, Cunningham MJ, Benjamin B, et al. Microdebrider tonsillotomy vs electrosurgical tonsillectomy: a randomized, double-blind, paired control study of postoperative pain. Arch Otolaryngol Head Neck Surg. 2006;132(6):599-604. doi:10.1001/archotol.132.6.599
16. Soaper AL, Richardson ZL, Chen JL, Gerber ME. Pediatric tonsillectomy: a short-term and long-term comparison of intracapsular versus extracapsular techniques. Int J Pediatr Otorhinolaryngol. 2020;133:109970. doi:10.1016/j.ijporl.2020.109970
17. Amin N, Bhargava E, Prentice JG, Shamil E, Walsh M, Tweedie DJ. Coblation intracapsular tonsillectomy in children: a prospective study of 1257 consecutive cases with long-term follow-up. Clin Otolaryngol. 2021;46(6):1184-1192. doi:10.1111/coa.13790
18. Odhagen E, Stalfors J, Sunnergren O. Morbidity after pediatric tonsillotomy versus tonsillectomy: a population-based cohort study. Laryngoscope. 2019;129(11):2619-2626. doi:1 0.1002/lary.27665
19. Sarny S, Habermann W, Ossimitz G, Stammberger H. What lessons can be learned from the Austrian events? ORL J Otorhinolaryngol Relat Spec. 2013;75(3):175-181. doi:10.1159/000342319
20. Schmidt R, Herzog A, Cook S, O’Reilly R, Deutsch E, Reilly J. Complications of tonsillectomy: a comparison of techniques. Arch Otolaryngol Head Neck Surg. 2007;133(9):925-928. doi:10.1001/archotol.133.9.925
21. Mukhatiyar P, Nandalike K, Cohen HW, et al. Intracapsular and extracapsular tonsillectomy and adenoidectomy in pediatric obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg. 2016;142(1):25-31. doi:10.1001/jamaoto.2015.2603
22. Cavaliere M, De Luca P, De Bonis E, et al. Partial intracapsular tonsillectomy in the treatment of pediatric obstructive sleep apnea/hypopnea syndrome: a prospective study with 5-year follow-up. Eur Arch Otorhinolaryngol. 2022;279(6):3089-3093. doi:10.1007/s00405-021-07119-3
23. Geißler K, Höppner M, Bitter T, Guntinas-Lichius O. Quality of life after combined adenoidectomy and laser tonsillotomy for pediatric sleep-disordered breathing: a prospective observational cohort trial. Int J Pediatr Otorhinolaryngol. 2025;194:112402. doi:10.1016/j.ijporl.2025.112402
2. Parker NP, Walner DL. Trends in the indications for pediatric tonsillectomy or adenotonsillectomy. Int J Pediatr Otorhinolaryngol. 2011;75(2):282-285. doi:10.1016/j.ijporl.2010.11.019
3. Koltai PJ, Solares CA, Koempel JA, et al. Intracapsular tonsillar reduction (partial tonsillectomy): reviving a historical procedure for obstructive sleep disordered breathing in children. Otolaryngol Head Neck Surg. 2003;129(5):532-538. doi:10.1016/S0194-5998 (03)00727-7
4. Walton J, Ebner Y, Stewart MG, April MM. Systematic review of randomized controlled trials comparing intracapsular tonsillectomy with total tonsillectomy in a pediatric population. Arch Otolaryngol Head Neck Surg. 2012;138(3):243-249. doi:10.1001/archoto.2012.16
5. Isaacson G, Parikh T. Developmental anatomy of the tonsil and its implications for intracapsular tonsillectomy. Int J Pediatr Otorhinolaryngol. 2008;72(1):89-96. doi:10.10 16/j.ijporl.2007.09.021
6. Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg. 2005;132(2):281-286. doi:10.1016/j.otohns.2004.09.007
7. Sagheer SH, Kolb CM, Crippen MM, et al. Predictive pediatric characteristics for revision tonsillectomy after intracapsular tonsillectomy. Otolaryngol Head Neck Surg. 2022;166(4):772-778. doi:10.1177/01945998211034454
8. Doshi HK, Rosow DE, Ward RF, April MM. Age-related tonsillar regrowth in children undergoing powered intracapsular tonsillectomy. Int J Pediatr Otorhinolaryngol. 2011;75(11):1395-1398. doi:10.1016/j.ijporl.20 11.07.036
9. Zhang Q, Li D, Wang H. Long term outcome of tonsillar regrowth after partial tonsillectomy in children with obstructive sleep apnea. Auris Nasus Larynx. 2014;41(3):299-302. doi:10.1016/j.anl.2013.12.005
10. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. doi:10.7326/M18-0850
11. Wang J, Dang PH, Chang HH, Wang ZH. Subtotal intracapsular tonsillectomy may be the first choice for tonsillectomy in children. J Int Med Res. 2021;49(5):3000605211011930. doi:10.1177/03000605211011930
12. Rinot E, Eisenbach N, Yakubovich I, et al. Intracapsular tonsillectomy improves children’s postoperative behavior measures. Int J Pediatr Otorhinolaryngol. 2025;191:112279. doi:10.1016/j.ijporl.2025.112279
13. Hultcrantz E, Ericsson E. Pediatric tonsillotomy with the radiofrequency technique: less morbidity and pain. Laryngoscope. 2004;114(5):871-877. doi:10.1097/00005537-200405000-00016
14. Derkay CS, Darrow DH, Welch C, Sinacori JT. Post-tonsillectomy morbidity and quality of life in pediatric patients with obstructive tonsils and adenoid: microdebrider vs electrocautery. Otolaryngol Head Neck Surg. 2006;134(1):114-120. doi:10.1016/j.otohns.2005.10.039
15. Lister MT, Cunningham MJ, Benjamin B, et al. Microdebrider tonsillotomy vs electrosurgical tonsillectomy: a randomized, double-blind, paired control study of postoperative pain. Arch Otolaryngol Head Neck Surg. 2006;132(6):599-604. doi:10.1001/archotol.132.6.599
16. Soaper AL, Richardson ZL, Chen JL, Gerber ME. Pediatric tonsillectomy: a short-term and long-term comparison of intracapsular versus extracapsular techniques. Int J Pediatr Otorhinolaryngol. 2020;133:109970. doi:10.1016/j.ijporl.2020.109970
17. Amin N, Bhargava E, Prentice JG, Shamil E, Walsh M, Tweedie DJ. Coblation intracapsular tonsillectomy in children: a prospective study of 1257 consecutive cases with long-term follow-up. Clin Otolaryngol. 2021;46(6):1184-1192. doi:10.1111/coa.13790
18. Odhagen E, Stalfors J, Sunnergren O. Morbidity after pediatric tonsillotomy versus tonsillectomy: a population-based cohort study. Laryngoscope. 2019;129(11):2619-2626. doi:1 0.1002/lary.27665
19. Sarny S, Habermann W, Ossimitz G, Stammberger H. What lessons can be learned from the Austrian events? ORL J Otorhinolaryngol Relat Spec. 2013;75(3):175-181. doi:10.1159/000342319
20. Schmidt R, Herzog A, Cook S, O’Reilly R, Deutsch E, Reilly J. Complications of tonsillectomy: a comparison of techniques. Arch Otolaryngol Head Neck Surg. 2007;133(9):925-928. doi:10.1001/archotol.133.9.925
21. Mukhatiyar P, Nandalike K, Cohen HW, et al. Intracapsular and extracapsular tonsillectomy and adenoidectomy in pediatric obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg. 2016;142(1):25-31. doi:10.1001/jamaoto.2015.2603
22. Cavaliere M, De Luca P, De Bonis E, et al. Partial intracapsular tonsillectomy in the treatment of pediatric obstructive sleep apnea/hypopnea syndrome: a prospective study with 5-year follow-up. Eur Arch Otorhinolaryngol. 2022;279(6):3089-3093. doi:10.1007/s00405-021-07119-3
23. Geißler K, Höppner M, Bitter T, Guntinas-Lichius O. Quality of life after combined adenoidectomy and laser tonsillotomy for pediatric sleep-disordered breathing: a prospective observational cohort trial. Int J Pediatr Otorhinolaryngol. 2025;194:112402. doi:10.1016/j.ijporl.2025.112402