儿童慢性扁桃体炎的治疗新进展
New Progress in the Treatment of Chronic Tonsillitis in Children
DOI: 10.12677/acm.2025.153704, PDF,   
作者: 李小岩, 张 峰, 姚红兵*:重庆医科大学附属儿童医院耳鼻咽喉头颈外科/国家儿童健康与疾病临床医学研究中心/儿童发育疾病研究教育部重点实验室,重庆
关键词: 儿童慢性扁桃体炎流行病学病因诊断治疗预防Chronic Tonsillitis in Children Epidemiology Etiology Diagnosis Treatment Prevention
摘要: 儿童慢性扁桃体炎是一种常见的上呼吸道慢性炎症性疾病,通常表现为扁桃体长期肿大、反复发作的炎症和伴随症状。其病因复杂,与反复急性扁桃体炎、免疫系统发育不完善、细菌或病毒感染等因素密切相关。临床症状包括咽喉不适、口臭、吞咽困难、打鼾及睡眠呼吸暂停等,严重者可影响儿童的生长发育和生活质量。诊断基于病史、体征和实验室检查,治疗方法包括保守治疗和手术。本综述旨在系统梳理并分析近年来关于儿童慢性扁桃体炎(chronic tonsillitis, CTL)的研究进展,涵盖其流行病学特征、潜在的病因机制、临床表现的异质性、诊断的挑战与策略,以及目前推荐的治疗方法和预防措施的有效性,并探讨未来研究方向的可能性。
Abstract: Chronic tonsillitis in children is a common chronic inflammatory disease of the upper respiratory tract, usually characterized by prolonged enlargement of the tonsils, recurrent inflammation and accompanying symptoms. Its etiology is complex and closely related to factors such as recurrent acute tonsillitis, underdevelopment of the immune system, and bacterial or viral infections. Clinical symptoms include throat discomfort, bad breath, dysphagia, snoring and sleep apnea, which in severe cases can affect children’s growth and development and quality of life. Diagnosis is based on history, signs and laboratory tests, and treatment includes conservative treatment and surgery. The purpose of this review is to systematically review and analyze the research progress of chronic tonsillitis (CTL) in children in recent years, covering its epidemiological characteristics, potential etiological mechanisms, heterogeneity of clinical manifestations, diagnostic challenges and strategies, as well as the effectiveness of currently recommended treatments and preventive measures, and explore possibilities for future research directions.
文章引用:李小岩, 张峰, 姚红兵. 儿童慢性扁桃体炎的治疗新进展[J]. 临床医学进展, 2025, 15(3): 990-998. https://doi.org/10.12677/acm.2025.153704

参考文献

[1] 黄选兆, 汪吉宝, 孔维佳. 实用耳鼻咽喉头颈外科学[M]. 第2版. 北京: 人民卫生出版社, 2008: 295-296.
[2] Windfuhr, J.P., Toepfner, N., Steffen, G., Waldfahrer, F. and Berner, R. (2016) Clinical Practice Guideline: Tonsillitis I. Diagnostics and Nonsurgical Management. European Archives of Oto-Rhino-Laryngology, 273, 973-987. [Google Scholar] [CrossRef] [PubMed]
[3] 吴兴宇. 儿童扁桃体切除对免疫功能的影响[J]. 现代诊断与治疗, 2015, 26(8): 1868-1869.
[4] 张小金, 罗志强. 儿童扁桃体炎病因及发病机制研究进展[J]. 现代医药卫生, 2013, 29(4): 551-553.
[5] 黎再云, 陈隆晖. 慢性扁桃体炎的临床治疗研究进展[J]. 西南军医, 2011, 13(4): 680-682.
[6] Alghamdi, F.A., Jawmin, B.A., Alghamdi, M.A., et al. (2024) Prevalence of Acute Tonsillitis and Its Association with Oral Hygiene Among the Population of Taif City, Saudi Arabia. Cureus, 16, e55801.
[7] 黄洪东, 彭佑铭. IgA肾病发病机制与腭扁桃体的关系研究[D]: [博士学位论文]. 长沙: 中南大学, 2007.
[8] 刘大波, 谷庆隆. 儿童急性扁桃体炎诊疗——临床实践指南(2016年制定) [J]. 中国实用儿科杂志, 2017, 32(3): 161-164.
[9] Gul, M., Okur, E., Ciragil, P., Yildirim, I., Aral, M. and Akif Kilic, M. (2007) The Comparison of Tonsillar Surface and Core Cultures in Recurrent Tonsillitis. American Journal of Otolaryngology, 28, 173-176. [Google Scholar] [CrossRef] [PubMed]
[10] 黄剑敏, 刘云亮, 张沁铭, 等. 儿童慢性扁桃体炎致病菌特征及耐药性分析[J]. 福建医药杂志, 2023, 45(1): 59-62.
[11] 左路杰, 耿江桥, 赫莉, 等. 388例儿童扁桃体肥大细菌学分析[J]. 中国耳鼻咽喉头颈外科, 2023, 30(8): 515-518, 526.
[12] Wang, Q., Du, J., Jie, C., Ouyang, H., Luo, R. and Li, W. (2017) Bacteriology and Antibiotic Sensitivity of Tonsillar Diseases in Chinese Children. European Archives of Oto-Rhino-Laryngology, 274, 3153-3159. [Google Scholar] [CrossRef] [PubMed]
[13] Kania, R.E., Lamers, G.E.M., Vonk, M.J., Huy, P.T.B., Hiemstra, P.S., Bloemberg, G.V., et al. (2007) Demonstration of Bacterial Cells and Glycocalyx in Biofilms on Human Tonsils. Archives of OtolaryngologyHead & Neck Surgery, 133, 115-121. [Google Scholar] [CrossRef] [PubMed]
[14] Kostić, M., Ivanov, M., Babić, S.S., Tepavčević, Z., Radanović, O., Soković, M., et al. (2022) Analysis of Tonsil Tissues from Patients Diagnosed with Chronic Tonsillitis—Microbiological Profile, Biofilm-Forming Capacity and Histology. Antibiotics, 11, Article 1747. [Google Scholar] [CrossRef] [PubMed]
[15] Sidell, D. and L. Shapiro, N. (2012) Acute Tonsillitis. Infectious DisordersDrug Targets, 12, 271-276. [Google Scholar] [CrossRef] [PubMed]
[16] Dias, E.P., da Rocha, M.L., de Oliveira Carvalho, M.O. and da Fonte de Amorim, L.M. (2009) Detection of Epstein-Barr Virus in Recurrent Tonsillitis. Brazilian Journal of Otorhinolaryngology, 75, 30-34. [Google Scholar] [CrossRef] [PubMed]
[17] Bartlett, A., Bola, S. and Williams, R. (2015) Acute Tonsillitis and Its Complications: An Overview. Journal of The Royal Naval Medical Service, 101, 69-73. [Google Scholar] [CrossRef
[18] Yan, Y., Song, Y., Liu, Y., Su, J., Cui, L., Wang, J., et al. (2019) Short-and Long-Term Impacts of Adenoidectomy with/without Tonsillectomy on Immune Function of Young Children < 3 Years of Age. Medicine, 98, e15530. [Google Scholar] [CrossRef] [PubMed]
[19] Onal, M., Kocak, N., Duymus, F., Bozkurt, M.K., Elsurer, C., Erdur, O., et al. (2021) Relationship of Endoplasmic Reticulum Stress with the Etiopathogenesis of Chronic Tonsillitis and Tonsillar Hypertrophy in Pediatric Patients: A Prospective, Parallel-Group Study. Molecular Biology Reports, 48, 5579-5586. [Google Scholar] [CrossRef] [PubMed]
[20] So, J.S. (2018) Roles of Endoplasmic Reticulum Stress in Immune Responses. Molecules and Cells, 41, 705-716.
[21] Safak, A.S., Bulut, F. and Cumbul, A. (2022) Histopathological Role of Vitamin D Deficiency in Recurrent/Chronic Tonsillitis Pathogenesis: Vascular Epithelial Growth Factor‐mediated Angiogenesis in Tonsil. Clinical and Experimental Dental Research, 8, 699-706. [Google Scholar] [CrossRef] [PubMed]
[22] Abu-elnasr Awwad, A., Hasan, R.A., Hablas, M.G.A., Mohammad Mohammad Abdelhay, O., Dawood, Y.M.A., Ahmed Mohamed, B., et al. (2023) Impact of Vitamin D in Children with Chronic Tonsillitis (Immunohistochemical Study of CD68 Polarisation and Proinflammatory Cytokines Estimation). Scientific Reports, 13, Article No. 8014. [Google Scholar] [CrossRef] [PubMed]
[23] Kaplan, E.L. (2011) Immunologic Impact of Tonsillopharyngitis Associated with Group a Streptococci. In: Harabuchi, Y., Hayashi, T. and Katada, A., Eds., Advances in Oto-Rhino-Laryngology, S. Karger AG, 129-131. [Google Scholar] [CrossRef] [PubMed]
[24] Stelter, K. (2014) Tonsillitis and Sore Throat in Children. GMS Current Topics in OtorhinolaryngologyHead and Neck Surgery, 13, Doc07.
[25] 陶丽. 阿莫西林/克拉维酸钾治疗小儿化脓性扁桃体炎效果及安全性[J]. 中国医药科学, 2021, 11(6): 97-99.
[26] 金建平, 陈红, 沈国荣, 等. 扁桃体及腺样体摘除术对6~12岁儿童免疫功能的影响[J]. 川北医学院学报, 2015, 30(5): 637-640.
[27] Song, L., Guo, J., Liao, W., Ye, P., Liu, L., Chen, T., et al. (2017) Long-Term Effects of Adenotonsillectomy on Serum-Specific Immunoglobulin E. Pediatric Research, 82, 801-805. [Google Scholar] [CrossRef] [PubMed]
[28] 赵东吉慧, 赵斯君, 黄敏, 等. 儿童腺样体扁桃体切除术后体质量变化的初步临床研究[J]. 实用临床医药杂志, 2019, 23(24): 71-73.
[29] Sakki, A.J., Mutka, A., Nokso-Koivisto, J. and Mäkinen, L.K. (2022) Do Tonsils Regrow after Partial Tonsillectomy?—Histology of Regrown Tonsils and Predisposing Factors for Tonsillar Regrowth. International Journal of Pediatric Otorhinolaryngology, 157, Article ID: 111132. [Google Scholar] [CrossRef] [PubMed]
[30] 刘蓉. 克感利咽口服液联合匹多莫德治疗儿童慢性扁桃体炎的疗效观察[J]. 齐齐哈尔医学院学报, 2016, 37(3): 368-369.
[31] Carta, S., Silvestri, M. and Rossi, G.A. (2013) Modulation of Airway Epithelial Cell Functions by Pidotimod: NF-κB Cytoplasmatic Expression and Its Nuclear Translocation Are Associated with an Increased TLR-2 Expression. Italian Journal of Pediatrics, 39, Article No. 29. [Google Scholar] [CrossRef] [PubMed]
[32] 周越;戴玉旋. 匹多莫德和脾氨肽对反复呼吸道感染患儿的 临床症状及Th1/Th2细胞因子影响的比较[J]. 中国生化药物杂志, 2012, 33(1): 64-66.
[33] 郑春林, 陈祖鸿. 手术与药物免疫调节治疗儿童慢性扁桃体炎的效果比较[J]. 临床合理用药杂志, 2022, 15(19): 170-172.
[34] 王娟, 汪玉洁, 王蓓. 小针刀联合中药治疗小儿慢性扁桃体肿大的临床观察[J]. 中国医药科学, 2024, 14(19): 106-109, 155.
[35] Xu, B., Jin, H., Wu, K., Chen, C., Li, L., Zhang, Y., et al. (2021) Primary and Secondary Postoperative Hemorrhage in Pediatric Tonsillectomy. World Journal of Clinical Cases, 9, 1543-1553. [Google Scholar] [CrossRef] [PubMed]
[36] Burton, M.J., Glasziou, P.P., Chong, L.Y. and Venekamp, R.P. (2014) Tonsillectomy or Adenotonsillectomy versus Non-Surgical Treatment for Chronic/Recurrent Acute Tonsillitis. Cochrane Database of Systematic Reviews, No. 11, CD001802. [Google Scholar] [CrossRef] [PubMed]
[37] Bellussi, L.M., Passali, F.M., Ralli, M., De Vincentiis, M., Greco, A. and Passali, D. (2019) An Overview on Upper Respiratory Tract Infections and Bacteriotherapy as Innovative Therapeutic Strategy. European Review for Medical and Pharmacological Sciences, 23, 27-38.