Adenotonsillektominin büyüme üzerine etkilerinin klinik ve biyokimyasal parametrelerle değerlendirilmesi

Amaç: Çalışmamızda adenotonsiller hipertrofiye bağlı üst hava yolu tıkanıklığı ve/veya yineleyen/kronik adenotonsil enfeksiyonunun büyüme ile ilişkisi, büyümenin klinik ve biyokimyasal parametrelerinin adenoidektomi ± tonsillektomi operasyonu öncesi ve sonrasında karşılaştırılması ile araştırılmıştır. Vücut kitle indeksi, boya göre ideal ağırlık yüzdesi, boy ve kilo standart sapma skorları ile IGF-I ve IGFBP3 seviyeleri büyümenin klinik ve biyokimyasal parametreleri olarak değerlendirilmiştir. Gereç ve yöntem: Bu amaçla; yineleyen/kronik adenotonsil enfeksiyonu ve/veya üst hava yolu tıkanıklığı semptomları olan ve tedavilerinde adenoidektomi ± tonsillektomi planlanan, 3 ile 8 yaşları arasında 42 çocuk çalışma kapsamına alındı. Bu çocuklar ailelerinden alınan öykü, fizik muayene ve radyolojik inceleme bulguları esas alınarak yineleyen/kronik enfeksiyon ve üst hava yolu tıkanıklığı ± yineleyen/kronik enfeksiyon olmak üzere 2 gruba ayrıldılar. Hastaların preoperatif/postoperatif boy ve kiloları stadiometer ve elektronik tartı kullanılarak ölçüldü. Preoperatif/postoperatif 6. ayda alınan periferik venöz kan örneklerinde serum IGF-I ve IGFBP3 düzeyleri kemiluminesans immunometrik yöntemi ile belirlendi. Bulgular: Birinci grupta sadece 1 hastanın preoperatif kilo değeri normalin altında iken; boy, vücut kitle indeksi, boya göre ağırlık yüzdesi değerleri ise tüm hastalar için normal sınırlarda idi. Toplam hasta grubunda ve II. grupta, I. gruptan farklı olarak postoperatif 6. ayda boy değerlerinde istatistiksel anlamlı artış saptandı. Birinci ve II. grup karşılaştırıldığında, aralarında preoperatif ve postoperatif kilo değerleri dışında, büyümenin klinik parametrelerinde anlamlı değişiklik saptanmadı. Çalışmamızda toplam hasta grubunda ve II. grupta, postoperatif serum IGF-I ve IGFBP3 düzeylerinde istatistiksel anlamlı artış saptadık. Birinci grupta postoperatif serum IGF-I düzeyleri, preoperatif düzeylere göre anlamlı artış gösterirken, IGFBP3 düzeylerinde anlamlı artış saptanmadı. Sonuç: Bu çalışmanın sonunda elde edilen veriler ile preoperatif dönemde hastaların boy ve kilo değerlerinin birlikte değerlendirilmesi ile, randomize olarak seçilmiş bu çocuklarda büyüme geriliğinin olmadığı söylenebilir. Her iki hasta grubu ve toplam hasta grubunda serum IGF-I düzeylerinde operasyon sonrası artış olması büyüme hormonu-IGF-I aksının olumlu yönde etkilendiğini ve adenotonsil problemi olan çocuklarda adenoidektomi ve/veya tonsillektominin büyümeyi hızlandırdığını göstermiştir.

The evaluation of effects of adenotonsillectomy on growth with clinical and biochemical parameters

Objective: In this study the relation between growth and upper airway obstruction due to adenotonsillar hypertrophy and/or recurrent/chronic adenotonsillary infection was investigated by comparing clinical and biochemical parameters before and after adenoidectomy ± tonsillectomy. Body mass index, weight for height percent, height and weight standart deviation scores and serum IGF-I and IGFBP3 levels were evaluated respectively as clinical parameters and biochemical parameters of growth. Material and Methods: With this aim, 42 children between the ages of 3 and 8 whose treatment was planned as adenoidectomy ± tonsillectomy with recurrent/chronic adenotonsillary infection and/or obstructive symptoms were included in the study. These children were divided into two groups as recurrent/chronic infection group and obstructive ± recurrent/chronic infection group depending on history, physical examination and radiological evaluation. The weight and height of the patients were measured with stadiometer and electronic scala preoperatively and postoperatively. Serum IGF-I and IGFBP3 levels were determined in venous blood samples obtained preoperatively and at the 6th month with chemiluminescent immunometric assay method. Results: In group I, only 1 patient's weight was under normal levels. Height, body mass index and weight for height percent values were normal in all the patients. At the postoperative 6th month, other than group I there was a statistically significant increase in height measures of group II and total patients. When group I and group II were compared with each other, there were no statistically significant differences in the clinical parameters of growth, except for preoperative and postoperative weight mesures. In our study, we found a statistically significant increase in serum IGF-I and IGFBP3 levels postoperatively in the total group and group II. In group I while serum IGF-I levels increased significantly when compared with preoperative levels, there was no statistically significant increase in IGFBP3 levels. Conclusion: When the results of this study and preoperative weight and height measures were considered together, it can be said that there is no growth retardation in these randomly selected children. In both groups and totally, increase in serum IGF-I levels has indicated that growth hormone-IGF-I axis was affected in a positive way and adenoidectomy and/or tonsillectomy accelerated the growth in the children with adenotonsillar problems.

Kaynakça

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