アデノイド摘出術後の難治性鼻づまりと関連する因子

Factors Associated with Refractory Nasal Congestion Following Adenoidectomy.

• Aneesh Patel
• Christopher D Brook
• Jessica R Levi

抄録

目的:

この研究の目的は、アデノイド摘出術を受けた小児患者の難治性鼻炎に関連する因子を、症状が改善した患者と比較してよりよく特徴づけることであった。

OBJECTIVE: The objective of this study was to better characterize factors associated with refractory rhinitis in pediatric patients who underwent adenoidectomy compared to those who had symptom resolution.

方法:

著者らは、2012年10月から2018年12月までにボストン医療センターでアデノイド摘出術を受けた18歳未満の患者を対象に症例シリーズを実施した。扁桃摘出術とアデノイド摘出術を受けた患者、または鼻炎以外の適応でアデノイド摘出術を受けた患者は除外した。術後に難治性の鼻炎症状を呈した患者と、症状が消失した患者をカイ二乗分析と-検定を用いて比較した。

METHODS: The authors conducted a case series of patients younger than 18 years old who underwent adenoidectomy at Boston Medical Center from October 2012 to December 2018. Patients who underwent tonsillectomy and adenoidectomy or who underwent adenoidectomy for indications other than rhinitis were excluded. Patients who had refractory rhinitis symptoms postoperatively were compared to those who had resolution of their symptoms using Chi-square analysis and -tests.

結果:

アデノイド摘出術後に難治性の症状を呈した患者133例を、症状が消失した患者139例と比較した。難治性症状を呈した患者では、鼻腔内生理食塩水、鼻腔内ステロイド、抗ヒスタミン剤、抗生物質を含む術前（1.50、＝0.0226）および術後（1.10、＜0.0001）の薬物使用の割合が有意に高く（89.3％、0.0011）、平均使用回数も高かった。術後のアレルギー評価（50％、0.0068）や再手術（30.1％、<0.0001）を受ける可能性が高く、アレルギーの既往歴を報告する割合が高かった（24.3％、0.0089）。

RESULTS: One hundred three patients who had refractory symptoms following adenoidectomy were compared to 139 patients who had resolution of symptoms. Patients who had refractory symptoms had significantly higher proportion of use (89.3%, .0011) and higher mean number of preoperative (1.50, = .0226) and postoperative (1.10, < .0001) medications, including nasal saline, intranasal steroids, antihistamines, and/or antibiotics. They were more likely to receive postoperative allergy evaluations (50%, .0068) and repeat surgery (30.1%, < .0001), and had a higher proportion of reported history of allergies (24.3%, .0089).

結論:

アデノイド摘出術後に難治性慢性鼻炎を発症した患者では、術前の薬剤の使用と数、アレルギーの既往歴の報告、術後のアレルギー評価が有意に高かった。本研究は，手術管理の臨床的意思決定に役立つ可能性のある難治性症状を発症した患者の違いを明らかにした．

CONCLUSION: Use and number of preoperative medications, reported history of allergies, and postoperative allergy evaluation were significantly higher in patients with refractory chronic rhinitis following adenoidectomy. This study identified differences in patients who developed refractory symptoms that may help clinical decision making for surgical management.