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首页> 外文期刊>Laryngo- rhino- otologie >From tonsil capping to tonsillectomy to tonsillotomy [Von der Mandelkappung über die Tonsillektomie zur Tonsillotomie]
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From tonsil capping to tonsillectomy to tonsillotomy [Von der Mandelkappung über die Tonsillektomie zur Tonsillotomie]

机译：从扁桃体加盖到扁桃体切除术到扁桃体切除术[从扁桃体加盖到扁桃体切除术到扁桃体切除术]

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摘要

From Tonsil Capping to Tonsillectomy to Tonsillotomy Medicine has been dealing with palatine tonsil disorders since its beginnings. With the initial aim of eliminating chronic centres of infl ammation, over time manifold surgical processes to extract tonsils were developed and tested. Very early on it already became clear that the complete extraction of the tonsil along its connective tissue capsule can lead to serious complications: the risk of bleeding after a tonsillectomy is well-known to currently practising surgeons. In order to reduce this risk and due to not yet existing safe anaesthesia, various techniques were developed aimed at merely reducing the size of the tonsils that is partially removing them within their capsules. Since only smaller intratonsillar blood vessels were aff ected in this process and bigger peritonsillar feeding arteries and veins remained unharmed, the risk of secondary haemorrhage was reduced considerably. The subtlest instruments for this process were created primarily during the 19 th century. This intracapsular, partial tonsillectomy, also referred to as tonsillotomy or tonsil capping , became widespread during that time. Due to its fast and easy application, as well as the low complication rates, it was used especially for children. However, the development of safer anaesthetic techniques at the beginning of the 20 th century meant that the extraction of the entire tonsil, tonsillectomy in toto, eventually became more feasible even in children. Against this background as well as a result of intense discussions on possible secondary scarring of the remaining tonsil tissue accompanied by infl ammatory after-eff ects, the technique of tonsillotomy, the partial extraction of the tonsils, was gradually abandoned in favour of that of tonsillectomy and eventually almost completely forgotten during the latter half of the 20 th century. The advances in sleep research and the discovery of general developmental physiological impairment arising from disrupted sleep patterns during infancy led to a rebirth of this surgical application. Tonsillotomy is currently widely accepted as a safe and eff ective method of treatment for obstructive sleep-related breathing disorders in children. However, due to the history of this procedure, the problem of possible long-term infl ammatory complications remains. In the following chapters, fi rst, an abstract of the history of the tonsillotomy is presented. Several historic papers on infl ammatory secondary disorders in large patient collectives will be introduced based on a search of the existing literature. Despite the correct diagnostic evaluation as well as the limitation to children unfavourable clinical experiences following a tonsillotomy could not be confi rmed even then. The development of tonsillotomy to full tonsillectomy procedures in the 20 th century will be illustrated by means of these historic sources.
机译：从扁桃体切除术到扁桃体切除术到扁桃体切开术，医学从一开始就致力于治疗tons扁桃体疾病。最初的目标是消除慢性炎症中心，随着时间的流逝，人们开发并测试了多种手术过程以提取扁桃体。很早以前就已经很清楚，扁桃体沿其结缔组织囊完全抽出会导致严重的并发症：扁桃体切除术后出血的风险是当前执业医生所熟知的。为了减少这种风险并且由于尚不存在安全麻醉，已开发了各种技术，旨在仅减小扁桃体的尺寸，从而将扁桃体部分地去除在其胶囊中。由于在此过程中仅影响较小的扁桃体内血管，而较大的扁桃体周围供血动脉和静脉仍未受到损害，因此可大大降低继发性出血的风险。此过程最细微的工具主要是在19世纪创建的。在此期间，这种囊内，部分扁桃体切除术（也称为扁桃体切除术或扁桃体封盖术）变得很普遍。由于它的快速简便的应用以及较低的并发症发生率，它特别用于儿童。然而，在20世纪初，更安全的麻醉技术的发展意味着整个扁桃体的摘除，扁桃体切除术甚至在儿童中最终变得更加可行。在这种背景下，以及由于对剩余扁桃体组织可能继发性瘢痕伴发通气后遗症的激烈讨论的结果，扁桃体切开术，扁桃体的部分提取技术逐渐被放弃，取而代之的是扁桃体切除术并最终在20世纪下半叶几乎完全被遗忘。睡眠研究的进展以及婴儿期睡眠模式中断引起的一般发育性生理障碍的发现，导致了这种外科手术方法的重生。扁桃体切开术目前已被广泛接受为儿童阻塞性睡眠相关呼吸障碍的一种安全有效的治疗方法。然而，由于该手术的历史，仍然存在可能的长期发炎并发症的问题。在接下来的章节中，首先介绍了扁桃体切开术的历史摘要。在检索现有文献的基础上，将介绍一些有关大型患者集体中的气发性继发性疾病的历史性论文。尽管做出了正确的诊断评估以及对儿童的限制，但即便如此，仍不能确认扁桃体切开术后不良的临床经验。这些历史资料将说明20世纪从扁桃体切除术到完整的扁桃体切除术的发展。

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