Evaluation of the effects of adenotonsillar hypertrophy and adenotonsillectomy on growth in children

Yıl 2012, Cilt: 47 Sayı: 4, 260 - 266, 01.12.2012

Levent Kartal Mehmet İlhan Şahin İsmail Külahlı Mustafa Kendirci

https://doi.org/10.4274/tpa.904

Öz

Aim: Several factors including genetic factors nutrition and environment play a critical role in the growth of children Adenotonsillar hypertrophy ATH can cause growth retardation by obstructing the upper airway Surgical treatment of ATH has been considered to have a positive effect on growth The aim of this study was to evaluate the role of chronic ATH on growth by measuring weight height body mass index BMI bone age serum insulin like growth factor 1 IGF 1 and insulin like growth factor binding protein 3 IGFBP 3 values before and after adenotonsillectomy Material and Method: The study was approved by the Ethics Committee 4 5 2004; 04 170 and written informed consents were obtained from parents of the participants A total of 40 prepubertal children who were diagnosed as chronic ATH were enrolled Obstructive symptoms were questioned in the medical history before surgery Weight height BMI and bone age values were measured and compared with reference values Preoperative serum IGF 1 and IGFBP 3 values were compared with the control group which consisted of healthy children Rates of obstructive symptoms weight height BMI bone age serum IGF 1 and IGFBP 3 values of the patients were determined seven months after adenotonsillectomy and were compared with preoperative values Results: Obstructive symptoms in children with ATH decreased remarkably after surgery Preoperative mean value of bone age of the patients was statistically lower than reference values p lt;0 05 and mean value of serum IGF 1 was lower than than the control group p lt;0 05 IGF 1 and IGFBP 3 values did not increase significantly after surgery p gt;0 05 However growth retardation was detected in three out of 40 patients based on the anthropometric measurements Conclusions: In this study antropometric findings showed that chronic ATH did not cause significant growth retardation in prepubertal children In addition we could not prove that surgical treatment of ATH improved the growth in the postoperative follow up period of seven months This result may be related with our study population with a limited number of patients who had baseline growth retardation and short postoperative follow up period Further studies with large number of patients and longer postoperative follow up periods are required to determine the exact role of chronic ATH in growth retardation Turk Arch Ped 2012; 47: 260 6

Anahtar Kelimeler

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Çocuklarda kronik adenotonsiller hipertrofinin büyüme üzerine etkilerinin adenotonsillektomi öncesi ve sonrası dönemde değerlendirilmesi

Öz

Amaç: Büyüme genetik beslenme ve çevresel etmenlerin rol oynadığı çok yönlü bir süreçtir Büyüme geriliğine neden olabilecek etmenler arasında üst hava yolu tıkanıklığı yapan adenotonsiller hipertrofi de yer almaktadır Adenotonsiller hipertrofinin cerrahi tedavisinin büyüme üzerine olumlu etkisi olduğu düşünülmektedir Bu çalışmada adenotonsillektomi öncesi ve sonrası dönemde ölçülen ağırlık boy beden kitle indeksi kemik yaşı serum insülin benzeri büyüme faktörü 1 IGF 1 ve insülin benzeri büyüme faktörü bağlama protein 3 IGFBP 3 değerleriyle kronik adenotonsiller hipertrofinin büyüme üzerine etkilerinin gösterilmesi amaçlanmıştır. 

Gereç ve Yöntem: Çalışma için etik kurul onayı 04 05 2004; no: 04 170 ve çocukların velilerinden bilgilendirilmiş gönüllü olur formu alındı Kronik adenotonsiller hipertrofi tanısı konan 40 ergenlik öncesi çocuk çalışmaya dahil edildi Ameliyat öncesi tıkayıcı belirtiler sorgulandı Hastaların ağırlık boy beden kitle indeksi ve kemik yaşı değerleri kaynak değerlerle karşılaştırıldı Ameliyat öncesi ölçülen serum IGF 1 ve IGFBP 3 değerleri 27 sağlıklı çocuktan oluşan kontrol grubununkilerle karşılaştırıldı Adenotonsillektomiden yedi ay sonra bulguların görülme oranı ve ağırlık boy beden kitle indeksi kemik yaşı serum IGF 1 ve IGFBP 3 değerleri saptanarak ameliyat öncesi değerlerle karşılaştırıldı. 

Bulgular: Tıkayıcı belirtilerin ameliyattan sonra belirgin şekilde azaldığı saptandı Hastaların kemik yaşı ortalamaları sağlıklı kaynak değerlere göre düşük bulundu p lt;0 05 Serum IGF 1 değerleri ameliyat öncesi dönemde kontrol grubuna göre istatistiksel olarak anlamlı düşük bulundu p lt;0 05 Ameliyattan sonra IGF 1 ve IGFBP 3 değerlerinde ameliyat öncesi döneme göre anlamlı artış gözlenmedi p gt;0 05 Bununla birlikte antropometrik ölçümlere göre 40 hastanın yalnız üçünde büyüme geriliği saptandı. 

Çıkarımlar: Bu çalışmada antropometrik bulgular kronik adenotonsiller hipertrofinin ergenlik öncesi çocuklarda önemli ölçüde büyüme geriliği yapmadığını göstermiştir Ayrıca adenotonsiller hipertrofinin cerrahi tedavisinin ameliyat sonrası yedi aylık dönemde büyümeyi hızlandırdığına ilişkin yeterli kanıt bulunamamıştır Bu sonuç hasta grubunda ameliyat öncesi büyüme geriliği olan az sayıda hasta olması ve ameliyat sonrası kısa izlem süresine bağlı olabilir Kronik adenotonsiller hipertrofinin ve cerrahi tedavisinin büyüme üzerine etkisinin anlaşılması için daha uzun postoperatif izlem süreli ve geniş çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Adenoid hipertrofi, adenotonsillektomi, antropometri, büyüme, IGF-1, IGFBP-3, kemik yaşı ölçümü, tonsil hipertrofisi, tonsillektomi

Kaynakça

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