生物与医学2018jamanetwork.com
儿童期切除腺样体或扁桃体后的长期健康风险
Long-term health risks after having adenoids or tonsils removed in childhood
进阶 · 约 35 分钟读完前置知识：流行病学基础、队列研究与风险比、基础统计推断
导读
这篇论文研究儿童期切除腺样体或扁桃体与日后长期健康风险之间的关联，利用人群数据比较手术与未手术儿童的后续疾病结局。结果提示这类常见手术并非没有代价，可能与某些长期疾病风险升高有关（具体病种需以原文为准）。
HN 关注点：腺样体/扁桃体切除在儿童中非常常见，而这篇研究挑战了“切了没关系”的默认做法，评论里也交织着家长亲身经历、PANDAS 争议和对医生过度手术的质疑。
后来怎么样
这是首批用全国登记数据系统量化扁桃体/腺样体切除术后长期疾病风险的研究之一，此后多项队列研究沿用类似设计，并使“手术并非零代价”成为临床与家长讨论手术指征时的常规议题。
HN 评论精选
这几条评论里：支持 1 补充 1 亲历 1
支持家长称医生在 PANDAS/轻微链球菌感染下仍强推腺样体扁桃体切除和抗生素，认为最新研究不支持手术。
非常感谢你发这个帖子。真的，谢谢你，陌生人。在捷克，医生总是强迫我们给儿子做腺样体/扁桃体切除（AE/TE），尽管他因链球菌感染症状轻微，而我们正在对抗 PANDAS。最新研究越来越一致地认为 AE/TE 无效，也说明我们不做手术是对的。看起来即使在最先进医疗机构里的医生也在这里盲目遵循旧教材，仍然一有机会就建议切除扁桃体，并且“以防万一”让人吃成袋的抗生素。这里医疗水平之低（可能外科除外）让我们现在主要只能靠自己头脑并收集最新研究。谢谢。
blackhaz查看英文原文
Thank you so much for posting this. Really, THANK YOU, kind stranger. Here in the Czech Republic we're always forced by doctors to do AE/TE to our son despite being mildly affected by strep as we are fighting PANDAS. The latest research converges on that AE/TE is not effective, and that we're doing the right thing by not doing the operation. It looks like doctors even in the most advanced medical institutions are blindly following old books here and still recommend to take the tonsils out at every occasion and eat bags of antibiotics "just for any case." The level of medicine here is so abysmal (except, probably, surgery) that we now have to rely mostly on our own heads and collect the latest research. Thank you.
亲历腺样体切除加鼓膜打孔带来的听力改善只维持两周，堵塞复发，可能需二次手术和置管；这类手术效果可能有限且反复。
我儿子去年切除了腺样体，因为某种黏液堵塞导致他听力非常差。医生向我们解释，内耳测量结果很好，所以没有腺样体他就能听得完全清楚。手术中他们切掉腺样体，并在每个耳膜上打孔让液体流出。术后他听力好到我们几乎耳语时他还叫我们别吼他——持续了两周。耳膜上的孔一愈合，堵塞又出现，他的听力跟术前完全一样。我们尝试了一年替代疗法，奇怪的含皮质类固醇的汁液之类（对他听力有效，但用药时他几乎睡不着），经鼻近红外照射（目前我们最喜欢，但因为腺样体位置太深效果不太好）……所以他很快要做第二次手术，可能再次切除腺样体（有时会再长）并在耳膜里放小管子，让液体能定期排出。我的远亲有同样问题但更严重（近乎耳聋导致语言发育迟缓），对他们来说手术有效了一年半，现在正面效果正在消退；也许还需要再做一次。我对此并不兴奋。
manmal查看英文原文
My son had adenoids removed last year because his hearing was VERY bad because of some kind of mucus blockage. Doctors explained to us that he would hear perfectly without the adenoids, because inner ear measurements were very good. So during the OP they cut away the adenoids, and made a hole into each eardrum, so fluids could exit. After the OP his hearing was so good that he told us not to scream at him when we barely whispered - for 2 weeks. As soon as the holes in the eardrums healed up, the blockage developed again and his hearing was exactly the same as before the OP. We tried alternative treatments for a year, strange juices with corticosteroids and stuff (which worked well for his hearing, but he couldn't really sleep while on them), near-infrared radiation through the nose (our favorite so far, but does not work that well because adenoids are too far in)... so he's soon have his second OP where they will likely remove adenoids again (they regrow sometimes) and insert little tubes into his eardrums such that fluids can regularly exit the ears. Distant relatives of mine have the same issue, but worse (delayed speech development due to near-deafness), and for them the OP worked for 1,5 years and now its positive effects are going away; perhaps requiring another OP. I'm not thrilled about all this. BTW here is advice a very expensive doc gave me regarding hearing and speech development: If your kid understands what you are saying while you whisper from a distance of ~1 meter, then her speech development should not be negatively affected, or not that much.
补充反向观点：腺样体肥大导致口呼吸，可能影响面部、下颌、牙齿和体态发育，手术并非全无必要，关键在时机。
让我提供一个值得考虑的替代视角。取决于病情严重程度，腺样体肥大可能导致正常经鼻呼吸出问题。呼吸显然对身体很重要，身体会找到适应方式，你就会发现自己用嘴呼吸。用嘴呼吸会促使长脸发育，因为舌头不在其自然位置——上颚顶部。你的姿势也会改变，因为长时间张嘴并不是身体的默认状态。你可能会发现脖子前伸。而这些还只是幼儿期不能正常呼吸的二三阶影响。下颌可能发育不良，牙齿也是。这些就是我知道的全部影响。是的，我最终切除了腺样体和扁桃体。不过不够早。
ponderatul查看英文原文
Let me provide you an alternative perspective worth considering. Depending on the seriousness of your condition, having adenoids can result in having problems breathing normally( aka through the nose). Now obviously breathing is very important for your organism, and it will find ways to adapt, and you will find yourself breathing through your mouth. Breathing through the mouth will encourage the development of a long face, cus tongue is not in its natural position, at the top of the palate. Your posture will change since having the mouth open is not the default position of the body for long periods of time. You might find your neck lunging forward. And these are just second and third order effects for not being to breathe properly during early childhood. Jaws might not develop properly, teeth as well. And that is all the effects I know about. Yes, I've had both my adenoids and tonsils removed, in the end. Not early enough though.
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